The Clinical Value Of Diagnostic Model Based On Liver Stiffness Measurement In Evaluating Liver Reserve Function

Objective:To establish a diagnostic model of liver reserve function in patients with compensated chronic liver disease based on liver stiffness measurement,and to evaluate its clinical value.Methods:A total of 360 patients with chronic liver disease（excluding decompensated liver cirrhosis）who underwent Fibro-scan test and indocyanine green clearance test in our hospital from March 2016 to June 2020 were included in this study,including 63patients with liver cancer and 297 patients without liver cancer,and there were 260males and 100 females,with an average age of 48.71±13.34 years old.The 15-minute retention rate of indocyanine green,LSM,blood routine examination,liver function,renal function,coagulation function and other indexes of all patients were collected.According to the relevant test results,the liver reserve function of all patients with chronic liver disease was evaluated by diagnostic model,including the Model of end-stage liver disease.（MELD）and Albumin-bilirubin（ALBI）model,Prothrombin time international normalized ratio to albumin ratio（PTAR）model.And then analyzed the correlation between LSM and different evaluation methods of liver reserve function,such as ICGR15 and MELD score,ALBI,PTAR,and analyzed the correlation between ICGR15 and different evaluation methods of liver reserve function,such as MELD score,ALBI,PTAR and so on.Through unconditional Logistic regression analysis,the discriminant diagnosis models of liver reserve function in groups Y₁,Y₂ and Y₃ were established according to the ICGR15 detection values of 10%,20%and 30%,respectively,the area under the curve,sensitivity,specificity,positive predictive value,negative predictive value and accuracy of each diagnostic model were obtained through Receiver operating characteristic curve（ROC）,and the clinical value of each diagnostic model was compared with MELD,ALBI and PTAR scores in the evaluation of liver reserve function.Results:（1）There was no significant difference in the scores of LSM,ICGR15,MELD,ALBI and PTAR between liver cancer group and non-liver cancer group.（2）In patients with chronic liver disease,LSM was significantly correlated with MELD,ALBI,PTAR score and ICGR15,with r values of 0.359,0.329,0.424 and 0.440 respectively,among which the correlation with ICGR15 was the strongest,ICGR15 was significantly correlated with MELD score,ALBI,PTAR and LSM,with r values of 0.319,0.430,0.418 and 0.440 respectively,among which the correlation with LSM was the strongest.（3）To define ICGR15≥10%as impaired liver reserve function,LSM（OR=1.019,95%CI 1.003-1.035）,PTAR（OR=1.469×10⁷,95%CI 6.446×10⁴-3.349×10⁸）,and age（OR=1.042,95%CI 1.019-1.065）as its independent influencing factors,a diagnostic model Y₁=0.021 LSM（k Pa）+13.813 PTAR-6.984 was constructed,and the area under the curve was 0.827（0.777-0.877）.（4）To define ICGR15≥20%as liver reserve function significantly impaired,LSM（OR=1.019,95%CI 1.003-1.035）,PTAR（OR=1.469×10⁷,95%CI 6.446×10⁴-3.350×10⁸）,age（OR=1.042,95%CI 1.019-1.065）as its independent influencing factors,a diagnostic model Y₂=0.019 LSM（k Pa）+16.503 PTAR+0.41 age-6.984 was constructed,and the area under the curve is 0.858（0.791-0.925）.（5）To define ICGR15≥30%as liver reserve function severely impaired,LSM（OR=1.028,95%CI 1.005-1.051）,PTAR(OR=9.009×10⁹,95%CI 1.405×10³-5.780×10¹²),age（OR=1.08,95%CI 1.023-1.140）as independent influencing factors,a diagnostic model Y₃=0.027 LSM（k Pa）+0.077 age+18.316 PTAR-16.503 was constructed,and the area under the curve is 0.906（0.843-0.969）.（6）The area under the curve of Y₁ diagnostic model was higher than that of MELD,ALBI and PTAR（0.827VS0.725,0.776,0.780）,and the accuracy of evaluating liver reserve function was higher（71.85%vs 76.17%,69.60%,72.47%）.The area under the curve of Y₂diagnostic model was higher than that of MELD,ALBI and PTAR（0.858VS0.783,0.847,0.879）,and the accuracy of evaluating liver reserve function was poor（71.23%vs 84.57%,84.64%,74.71%）.The area under the curve of Y₃ diagnostic model was higher than that of MELD,ALBI and PTAR（0.906VS0.709,0.706,0.771）,and the accuracy of evaluating liver reserve function was the highest（87.52%vs 84.23%,85.26%,74.46%）.Among the three diagnostic models of Y₁,Y₂ and Y₃,the area under the curve and accuracy of Y₃ diagnostic model were the highest.Conclusion:The diagnostic model based on LSM has a good discriminant effect on different degrees of liver reserve function in patients with chronic liver disease,and it is possible to replace ICG clearance test to evaluate liver reserve function in clinic,especially for identifying patients with severe liver reserve function damage.