The Predictive Value Of RPR, PLR, NLR, And APRI In The Compensatory Phase Of Liver Cirrhosis

Objective:Observe the expression of red blood cell distribution width/platelet count(RPR),platelet count/lymphocyte count(PLR),neutrophil count/lymphocyte count(NLR),aspartate aminotransferase/platelet count(APRI)in liver disease and cirrhosis,and explore whether the above indicators have the value of predicting the occurrence of cirrhosis,and explore whether they have predictive value in the occurrence of cirrhosis of different causes.Methods:During the period from January 2010 to June 2022,we conducted an experiment in the Affiliated Hospital of Yan’an University,collecting a total of 5 0 patients with viral hepatitis,44 patients with post viral hepatitis,3 1 patients with autoimmune liver disease,3 3 patients with post autoimmune liver disease,and 3 9 patients with fatty liver disease.Among them,3 1 patients had symptoms of compensatory liver cirrhosis.We also analyzed the clinical and pathological data of patients with liver diseases and corresponding causes of cirrhosis,and analyzed whether there were differences in the expression of RPR,PLR,NLR,and APRI in patients with liver diseases and corresponding causes of cirrhosis during the compensatory period,so as to explore whether they had predictive value for the occurrence of cirrhosis during the compensatory period,and whether they were suitable for different causes of cirrhosis.Results:1.There are 94 patients with viral hepatitis and viral hepatitis related cirrhosis in the compensatory period,including 50 in the viral hepatitis group and 44 in the viral cirrhosis compensatory period group,including 62 males(66%)and 32 females(34%).Of these,35(56.5%)men had cirrhosis and 9(28.1%)women had cirrhosis.After grouping according to age,there were 58(61.7%)patients aged≥50 years,of which 3 5(60%)were patients with compensated cirrhosis,36(38.3%)patients aged<50 years,and 9(25%)were patients with compensated cirrhosis.According to the grouping based on BMI,there were 13(13.8%)patients with a BMI lower than 18,of which 7(53.8%)were patients with compensated cirrhosis,51(54.3%)patients with a BMI between 18 and 24,of which 26(51%)were patients with compensated cirrhosis,30(3 1.9%)patients with a BMI higher than 24,and 11(36.7%)were patients with compensated cirrhosis.According to whether there is a family history of chronic viral hepatitis,72(76.6%)cases have a family history of chronic viral hepatitis,of which 3 5(48.6%)cases are patients with compensatory liver cirrhosis,22(23.4%)cases have no family history,and 9(20.5%)cases are patients with compensatory liver cirrhosis.After general data analysis,there were statistical differences in gender and age between the two groups.Men were associated with the onset of compensatory cirrhosis(X2=6.802,P=0.009<0.05),and age≥50 years was associated with the onset of compensatory cirrhosis(X2=6.836,P=0.009<0.05).Compared with the chronic viral hepatitis group,the platelet,albumin,total protein,and PLR indicators in the cirrhotic group decreased,while AST,ALT,GGT,TBil,red blood cell distribution width,RPR,and APR scores increased in the cirrhotic group(P<0.05).The ROC curve results showed that the best cutoff values for RPR,PLR,and APRI in predicting the occurrence of viral hepatitis related cirrhosis were 0.075(sensitivity 0.864,specificity 0.78),81.967(sensitivity 0.70,specificity 0.82),and 0.205(sensitivity 0.727,specificity 0.96),respectively.The AUC values were 0.863(P<0.001),0.779(P<0.001),and 0.808(P<0.001),respectively.Area under the combined diagnostic curve of RPR,PLR,and APRI was 0.904(P<0.01).2.This group has a total of 64 patients with autoimmune liver disease and autoimmune liver disease related cirrhosis in the compensatory period,including 3 1 patients in the autoimmune liver disease group and 3 3 patients in the autoimmune liver disease related cirrhosis in the compensatory period group.Of the 19 male patients(29.7%),10(52.6%)are patients with cirrhosis in the compensatory period,and of the 4 5 female patients(70.3%),23(51.5%)are patients with cirrhosis in the compensatory period.Aftergrouping according to age,there were 46(71.9%)patients aged ≥50 years,of which 27(58.7%)were patients with compensated cirrhosis,18(28.1%)patients aged<50 years,and 6(33.3%)were patients with compensated cirrhosis.According to the grouping based on BMI,there were 2(3.1%)patients with a BMI lower than 18,of which 1(50%)patients were in the compensatory phase of liver cirrhosis,4 3(67.2%)patients with a BMI between 18 and 24,of which 21(48.8%)patients were in the compensatory phase of liver cirrhosis,19(29.7%)patients with a BMI higher than 24,and 11(57.9%)patients were in the compensatory phase of liver cirrhosis.According to whether there is a family history of autoimmune diseases,there are12(18.8%)patients with a family history,of which 7(58.3%)patients are in the compensatory stage of liver cirrhosis,52(8 1.3%)patients without a family history,of which 26(50%)patients are in the compensatory stage of liver cirrhosis.There was a statistically significant difference in age between the two groups.Age ≥50 years old was associated with the onset of compensatory cirrhosis(X2=1.296,P=0.048<0.05).Compared with the autoimmune liver disease group,the patients in the compensated stage of liver cirrhosis group had lower white blood cell counts,lymphocyte counts,neutrophil counts,platelets,albumin,and PLR indicators,while ALT,GGT,red blood cell distribution width,RPR,and APRI scores were all increased(P<0.05).The ROC curve results showed that the best cutoff values for RPR,PLR,and APRI in predicting the occurrence of autoimmune liver disease related cirrhosis were 0.095(sensitivity 0.818,specificity 0.774),100(sensitivity 0.85,specificity 0.645),and 0.205 area under the curve(AUC)were 0.848(P<0.001),0.832(P<0.001),and 0.427(P=0.317).The area under the curve for combined diagnosis of RPR and PLR was 0.865(P<0.001).PLR and RPR had predictive value for the compensatory phase of liver cirrhosis,while APRI had poor predictive value.3.In this group,there are 70 patients with fatty liver disease and fatty liver disease related cirrhosis in the compensatory period,including 39 patients in the fatty liver disease group and 3 1 patients in the fatty liver disease related cirrhosis in the compensatory period group.Among the 49 male patients(70%),24(49%)are patients with cirrhosis in the compensatory period,and among the 21 female patients(3 0%),7(22.6%)are patients with cirrhosis in the compensatory period.After grouping according to age,there were 3 5(50%)patients aged ≥50 years,of which 14(40%)were patients with compensated cirrhosis,and 35(50%)patients aged<50 years,of which 17(48.6%)were patients with compensated cirrhosis.According to the grouping based on BMI,there were 5(7.1%)patients with a BMI lower than 18,of which 2(40%)were patients with compensated cirrhosis,34(48.6%)patients with a BMI between 18 and 24,of which 12(35.3%)were patients with compensated cirrhosis,3 1(44.3%)patients with a BMI higher than 24,and 17(54.8%)were patients with compensated cirrhosis.According to whether there is a family history of hyperlipidemia,there are 24(3 4.3%)cases with a family history,of which 5(20.8%)cases are patients with compensatory liver cirrhosis,46(65.7%)cases without a family history,and 26(56.5%)cases are patients with compensatory liver cirrhosis.According to whether there is a long-term drinking history,20(50%)of the 40(57.1%)patients with a long-term drinking history are patients with compensatory liver cirrhosis,and 11(35.5%)of the 30(42.9%)patients without a long-term drinking history are patients with compensatory liver cirrhosis.After general data analysis,there were significant differences in family history and whether there was a history of alcohol consumption between the two groups.A family history of hyperlipidemia was associated with the occurrence of compensatory periods of fatty liver disease related cirrhosis(X2=8.141,P=0.04<0.05),while patients with a long-term history of alcohol consumption were associated with the occurrence of compensatory periods of fatty liver disease related cirrhosis(X2=7.3,P=0.03<0.05).Compared with patients with fatty liver disease,patients in the compensatory phase of liver cirrhosis associated with fatty liver disease had lower platelet,albumin,and PLR indicators,while AST,red blood cell distribution width,RPR,and APRI scores were all increased(P<0.05).The ROC curve results showed that the best cutoff values for RPR,PLR,and APRI in predicting the occurrence of fatty liver disease related cirrhosis were 0.085(sensitivity 0.613,specificity 0.821),100(sensitivity 0.839,specificity 0.795),and 0.215(sensitivity 0.774,specificity 0.769),respectively.The area under the curve(AUC)was 0.815(P<0.001),0.840(P<0.001),and 0.785(P<0.001),respectively,The predictive value of PLR and RPR in the compensatory phase of liver cirrhosis is superior to APRI.The combined prediction of RPR,PLR,and APRI for the occurrence of compensated fatty liver cirrhosis was 0.867(P<0.01).Conclusions:1.RPR is highly expressed in the compensatory phase of liver cirrhosis,with a statistically significant difference compared to liver disease,and has the same conclusion in three different types of compensatory phase of liver cirrhosis.2.The expression of PLR in the compensatory phase of liver cirrhosis is relatively low,with a statistically significant difference compared to liver disease,and has the same conclusion in three different types of compensatory phase of liver cirrhosis.3.There is no significant difference in the expression of NLR in liver diseases and corresponding compensatory stages of cirrhosis,and the same conclusion is reached in three different types of compensatory stages of cirrhosis.4.APRI is highly expressed in the compensatory phase of liver cirrhosis,with a statistically significant difference compared to liver disease.APRI has the same conclusion in the compensatory phase of viral and fatty liver cirrhosis,but there is no statistically significant difference in the compensatory phase of autoimmune liver disease and related liver cirrhosis.5.The combination of RPR,PLR,and APRI has greater predictive value,greater than the predictive value of each individual indicator,and has the same conclusion in the compensatory phase of viral hepatitis cirrhosis and fatty liver disease related cirrhosis.RPR and PLR have good value in the compensatory phase of autoimmune liver cirrhosis,and the combination has better predictive value.APRI has no statistical significance in the compensatory phase of autoimmune liver disease related cirrhosis...