Aspartate aminotransferase-to-platelet ratio index (APRI) for the non-invasive prediction of esophageal varices

Mattos, Ângelo Zambam de; Mattos, Ângelo Alves de; Daros, Larissa Faraco; Musskopf, Maiara Isabel

doi:10.1016/s1665-2681(19)31324-9

Cited by 27 publications

(8 citation statements)

References 21 publications

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“…This was comparable to diagnostic performance of spleen stiffness and spleen area. Nevertheless, these findings differ to those in the literature, which has described lower sensitivities in higher cut-off values[ 24 - 26 ]. Only one study by Salzl et al [ 16 ] demonstrated a similar diagnostic performance (AUROC 0.805), but the cut-off value (1.90) remained higher than seen in our cohort[ 16 ].…”

Section: Discussioncontrasting

confidence: 99%

Non-invasive splenic parameters of portal hypertension: Assessment and utility

Ahmad¹,

Atzori²,

Maurice³

et al. 2020

WJH

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BACKGROUND Portal hypertension is a major complication of cirrhosis that is associated with significant morbidity and mortality. The present gold-standard method to risk stratify and observe cirrhosis patients with portal hypertension is hepatic venous pressure gradient measurement or esophagogastroduodenoscopy. However, these methods are invasive, carry a risk of complications and are associated with significant patient discomfort. Therefore, non-invasive splenic parameters are of clinical interest as potential useful markers in determining the presence of portal hypertension. However, diagnostic accuracy and reproducibility remains unvalidated. AIM To assess the diagnostic accuracy of spleen stiffness, area and diameter in predicting the presence of portal hypertension. METHODS Of 50 patients with varying liver disease pathologies were prospectively recruited from the St. Mary’s Hospital Liver Unit in London; 25 with evidence of portal hypertension and 25 with no evidence of portal hypertension. Liver stiffness, spleen stiffness, spleen diameter and spleen area were measured using the Philips Affiniti 70 elastography point quantification point shear wave elastography system. The aspartate aminotransferase-to-platelet-ratio-index (APRI) score was also calculated. Performance measures, univariate and multivariate logistic regression were used to evaluate demographic, clinical and elastography variables. Interclass correlation coefficient was used to determine the reproducibility of splenic area and diameter. RESULTS On univariate and individual performance, platelet count [area under the receiver operating characteristic (AUROC) 0.846, P value < 0.001], spleen area (AUROC 0.828, P value = 0.002) and APRI score (AUROC 0.827, P value < 0.001) were the most accurate variables in identifying the presence of portal hypertension. On multivariate logistic regression models constructed, the combination of spleen area greater than 57.90 cm 2 and platelet count less than 126 × 10 9 had 63.2% sensitivity and 100% specificity, 100% positive predictive value and 100% negative predictive value. An alternative combination of spleen stiffness greater than 29.99 kPa and platelet count less than 126 × 10 9 had 88% sensitivity, 75% specificity, 78.6% positive predictive value and 85.7% negative predictive value. An interclass correlation coefficient value of 0.98 (95%CI: 0.94-0.99, P value < 0.001) and 0.96 (95%CI: 0.91-0.99, P value < 0.001) were determined for inter-operator variability for spleen area and diameter respectively. CONCLUSION Spleen area, spleen stiffness and platelet count may be useful markers to assess the presence of portal hypertension in patients of various etiologies...

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Section: Discussioncontrasting

confidence: 99%

Non-invasive splenic parameters of portal hypertension: Assessment and utility

Ahmad¹,

Atzori²,

Maurice³

et al. 2020

WJH

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“…As a result, numerous studies have evaluated the ability of the various non-invasive scores to identify patients at risk for clinically significant varices. [16][17][18] Although thrombocytopenia is associated with large esophageal varices, the level of sensitivity is not adequate to be employed clinically. Likewise, meta-analyses of the various non-invasive scores that include the platelet count have low to moderate accuracy.…”

Section: Presence Of Esophageal Varices and High-risk Varicesmentioning

confidence: 99%

<p>Clinical Implications of Thrombocytopenia for the Cirrhotic Patient</p>

Sigal¹,

Sherman

Jesudian

2020

HMER

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Thrombocytopenia is a frequent complication in patients with cirrhosis. As many as 84% of patients with cirrhosis have thrombocytopenia, and it is an independent variable indicative of advanced disease and poor prognosis. Although there is great concern that it may aggravate bleeding during surgical procedures, there is limited evidence to inform decisions regarding the treatment of cirrhotic patients with thrombocytopenia undergoing invasive procedures. Finally, there is evidence that platelets play a significant role in liver regeneration. In this report, the clinical implications of thrombocytopenia in cirrhotic patients are reviewed. The utility of platelet counts in the prognosis of cirrhosis and relationship to complications of advanced liver disease, including portal hypertension, esophageal varices, and hepatocellular carcinoma. The impact of low platelet counts on bleeding complications during invasive procedures is outlined. Finally, the role of platelets and potential adverse impact in liver regeneration is reviewed.

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“…It was first established in predicting liver fibrosis in subjects with hepatitis C [14]. Mattos et al disclosed that APRI characterized 64.7% sensitivity and 43.2% negative predictive value in predicting esophageal varices in subjects with cirrhosis [15]. More recently, Mandal et al demonstrated that APRI with a threshold of 0.908 characterized 87.3% sensitivity, 71.4% specificity, 92% positive predictive value, and 60% negative predictive value [16].…”

Section: Laboratory Parametersmentioning

confidence: 99%

The Role of Invasive and Non-Invasive Measurements of HVPG in Decision Making in Patients With Portal Hypertension and Esophageal Varices

Witkowski

Arłukowicz

Bojko³

et al. 2021

Wiad Lek

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Many researchers and clinicians have taken the value of hepatic venous pressure gradient (HVPG) as an essential prognostic factor in subjects with chronic liver disorders. And HVPG alterations characterize a predictive value in subjects at the beginning of the disease (HVPG 6 – 10 mmHg) as well as in subjects in whom hemodynamically significant portal hypertension has developed (HVPG ≥ 10 mmHg). Our review aims to present the feasibility and applicability of HVPG in modern clinical practice in patients with liver cirrhosis, including invasive and non-invasive methods. HVPG measurement is a feasible method with a favorable safety profile. However, hemodynamically significant portal hypertension also might be determined using non-invasive options as elastography, magnetic resonance imaging, and indices derived from laboratory parameters, e.g., aspartate aminotransferase-to-platelet ratio, platelet count/spleen diameter ratio, or VITRO score. Hepatic vein catheterization with the evaluation of HVPG is the current gold standard for determining portal pressure; however, new non-invasive techniques are nowadays more frequently used.

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Aspartate aminotransferase-to-platelet ratio index (APRI) for the non-invasive prediction of esophageal varices

Cited by 27 publications

References 21 publications

Non-invasive splenic parameters of portal hypertension: Assessment and utility

Non-invasive splenic parameters of portal hypertension: Assessment and utility

<p>Clinical Implications of Thrombocytopenia for the Cirrhotic Patient</p>

The Role of Invasive and Non-Invasive Measurements of HVPG in Decision Making in Patients With Portal Hypertension and Esophageal Varices

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