Correlation Analysis Of Non-invasive Indexes Such As APRI With Esophageal Varices And First Bleeding In Liver Cirrhosis

Background and ObjectivesCirrhosis is the end stage of liver disease caused by different etiologies.Viral hepatitis cirrhosis is the most common cirrhosis in China,which can cause the decrease of liver function and portal hypertension.And the esophageal varices(EV)caused by portal hypertension is very common.The esophageal varices bleeding(EVB),which is a kind of serious complications,is a common cause of death in patients with cirrhosis.So detecting EV early can avoid EVB and greatly reduce the mortality of the patients with cirrhosis.The current gold standard for diagnosing EV is upper gastrointestinal endoscopy(UGIE).UGIE is an invasive examination and the price is relatively expensive.Long-term follow-up with UGIE has caused great economic burden and poor compliance for patients.UGIE may cause nausea,vomiting and other unpleasant experiences.Many patients have contraindications,such as advanced age,severe anemia,poor coagulation function,etc.UGIE has high requirements for endoscopic physicians,which requires careful operation and observation.Medical equipments in primary hospitals are relatively backward and some hospitals don’t have endoscopic equipments.Therefore,it is necessary to explore non-invasive indicators to diagnose EV so that EV can be detected in time and the number of endoscopic surgeries can be reduced.In this study,the serological indexes and color doppler ultrasonography of EV in patients with cirrhosis of different etiologies were collected in order to find out the non-invasive indexes that can effectively diagnose EV and analyze the diagnostic values of EV in patients with cirrhosis of different etiologies.The indicators associated with first hemorrhage in EV patients were also studied in order to take time measures to reduce the occurrence of EVB.MethodsA total of 276 patients with cirrhosis who underwent UGIE in the Department of Gastroenterology,the Second Affiliated Hospital of Zhengzhou University from August 2015 to September 2020 were collected,including 114 patients with hepatitis B cirrhosis,62 patients with hepatitis C cirrhosis,45 patients with alcoholic cirrhosis,30 patients with autoimmune cirrhosis and 25 patients with unknown etiologies.According to the UGIE test results,they were divided into no EV group and EV group.The sex,age,etiologies,ascites,portal vein diameter,spleen thickness,platelet,alanine transaminase,aspartic acid transferase,glutamyltransferase,total bilirubin,prothrombin time,prothrombin activity,APRI score and Child-Pugh classification were recorded.Univariate analysis was used to find the indicators with statistical significance and binary logistic regression analysis was performed on these indicators to obtain the indicators that could independently diagnose EV.Receiver operating characteristic curve of the subjects was drawn and the area under the ROC curve was used to analyze the diagnostic efficiency of each indicator and evaluate the diagnostic values of these indicators for EV with cirrhosis of different etiologies.All patients diagnosed with EV were divided into no EVB group and EVB group according to whether they had first hemorrhage.The above indicators,EV degree and the red sign or not in the two groups were recorded.Kendall analysis was used to screen out indicators of statistical significance so as to analyze the indexes that have correlation with the first bleeding in EV patients with cirrhosis.Results(1)Among 276 patients with cirrhosis,106 were in the no EV group and 170 were in the EV group.Univariate analysis showed that the indexes of statistical significance were ascites,PVD,ST,PLT,AST,TBIL,PTA,APRI score and Child-Pugh classification(P < 0.05).There was no significant difference in gender(χ2 = 0.214,P=0.644),age,ALT,GGT,PT(P>0.05).Binary logistic regression analysis of the above indicators with statistical significance indicated that PVD,ST,APRI score and Child-Pugh classification had statistical significance(P < 0.05).ROC curve was drawn to evaluate the diagnostic value of PVD,ST and APRI score in EV patients.The results indicated that the AUC of PVD,ST and APRI were 0.802,0.650 and 0.755 respectively.The diagnostic value was the highest when the value of PVD was 12.75 mm,with a sensitivity of 84.7% and a specificity of 63.2%.The sensitivity was 48.8% and the specificity was 83% when the ST value was 48.5mm.When APRI was 2.33,the sensitivity and specificity were 60.6% and 79.2% respectively.(2)When PVD and APRI were combined to draw ROC curve,the AUC was 0.853.The sensitivity and specificity of PVD in EV diagnosis were 77.1% and 88.1%,which were higher than the value of a single index in EV diagnosis.(3)The ROC curves of PVD,APRI,and the combination of PVD and APRI for EV diagnosis with cirrhosis of different etiologies showed that the AUC values of EV in the group of hepatitis B,hepatitis C,alcoholic liver,autoimmune liver,and unexplained cirrhosis were 0.831,0.876,0.810,0.818,0.801 respectively.The AUC values of EV diagnosed by APRI were 0.793,0.805,0.750,0.713,0.583 respectively.The AUC values of PVD combined with APRI in EV diagnosis were 0.884,0.916,0.824,0.820 and 0.807.(4)The 170 patients were divided into EVB group and no EVB group.Kendall correlation analysis was performed for PVD,ST,PLT,ALT,AST,GGT,TBil,PT,PTA,APRI score,age,sex,ascites,EV degree,red sign or not,Child-Pugh classification,etc.The results indicated that the ascites,EV degree,red sign and Child-Pugh classification were positively correlated with EVB,while PLT and PTA were negatively correlated with EVB,and the correlation coefficients were 0.317,0.815,0.833,0.796,-0.682 and-0.615 respectively.Conclusions(1)The PVD,APRI,ST and Child-Pugh classification can independently predict the existence of EV.(2)PVD combined with APRI has a medium diagnostic value for EV,and a relatively high diagnostic value for EV in viral hepatitis cirrhosis,it has the highest diagnostic value for EV caused by hepatitis C.(3)PLT,PTA,ascites,EV degree,red sign,Child-Pugh classification are correlated with EVB.The lower PLT and PTA,the greater volume of peritoneum,the higher EV degree,the more severe red sign,and the higher Child-Pugh classification,the higher risk of first bleeding the EV patients occur.