medigraphic.com
Órgano Oficial de la Asociación Mexicana de Hepatología

2013, Number 5

<< Back Next >>

Ann Hepatol 2013; 12 (5)

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

Zambam MÁ, Alves MA, Faraco DL, Musskopf MI

Language: English
References: 24
Page: 810-814
PDF size: 90.68 Kb.


ABSTRACT

Background & Aims. Variceal bleeding is a dramatic and common complication of cirrhosis, and, therefore, endoscopy is recommended for the screening of EV (esophageal varices) in every cirrhotic. This study evaluates the capacity of APRI (aspartate aminotransferase-to-platelet ratio index) in non-invasively predicting EV. Material and methods. This cross-sectional study evaluated cirrhotics for their APRI value and the presence of EV, with a cutoff point of 1, 3; platelet count, spleen diameter, PC/SD (platelet count/ spleen diameter ratio), aspartate aminotransferase/alanine aminotransferase ratio, Child-Pugh score and MELD (model for end-stage liver disease) score were also studied. Results. The study included 164 cirrhotics, 59.7% male, with a mean age of 56.7 years. APRI demonstrated a sensitivity of 64.7% (95% confidence interval-95%CI = 0.56-0.73), specificity of 72.7% (95%CI = 0.59-0.86), positive predictive value of 86.5% (95%CI = 0.79-0.94), negative predictive value of 43.2% (95%CI = 0.32-0.55). In the univariate analysis, platelet count, spleen diameter, Child and MELD scores, PC/SD and APRI were related to EV (p ‹ 0.05). In the logistic regression, only platelet count and Child score were associated to EV (p ‹ 0.05). Conclusion. APRI is not an independent factor for the prediction of EV. Its sensitivity, specificity and predictive values are insufficient for the index to be used for the screening of EV in cirrhotics.


REFERENCES

  1. Giannini E, Botta F, Borro P, Risso D, Romagnoli P, Fasoli A, Mele MR, et al. Platelet count/spleen diameter ratio: proposal and validation of a non-invasive parameter to predict the presence of oesophageal varices in patients with liver cirrhosis. Gut 2003; 52: 1200-5.

  2. Bosch J, Berzigotti A, Garcia-Pagan JC, Abraldes JG. The management of portal hypertension: rational basis, available treatments and future options. J Hepatol 2008; 48: S68-S92.

  3. Garcia-Tsao G, Sanyal AJ, Grace ND, Carey W; Practice Guidelines Committe of the American Association for the Study of Liver Diseases, the Practice Parameters Committee of the American College of Gastroenterology. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology 2007; 46: 922-38.

  4. De Franchis R, Baveno V Faculty. Revising Consensus in Portal Hypertension: Report of the Baveno V Consensus Workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol 2010; 53: 762-8.

  5. Garcia-Tsao G. Portal hypertension. Curr Opin Gastroenterol 2006; 22: 254-62.

  6. Berzigotti A, Gilabert R, Abraldes JG, Nicolau C, Bru C, Bosch J, García-Pagan JC. Noninvasive prediction of clinically significant portal hypertension and esophageal varices in patients with compensated liver cirrhosis. Am J Gastroenterol 2008; 103: 1159-67.

  7. Burton JR, Liangpunsakul S, Lapidus J, Giannini E, Chalasani N, Zaman A. Validation of a multivariate model predicting presence and size of varices. J Clin Gastroeneterol 2007; 41: 609-15.

  8. De Franchis R, Dell’Era A. Diagnosis and therapy of esophageal vascular disorders. Curr Opin Gastroenterol 2007; 23: 422-7.

  9. De Franchis R. Noninvasive diagnosis of esophageal varices: is it feasible? Am J Gastroenterol 2006; 101: 2520-2.

  10. Thomopoulos KC, Labropoulou-Karatza C, Mimidis KP, Katsakoulis EC, Iconomou G, Nikolopoulou VN. Non-invasive predictors of the presence of large oesophageal varices in patients with cirrhosis. Dig Liver Dis 2003; 35: 473-8.

  11. Giannini EG, Botta F, Borro P, Dulbecco P, Testa E, Mansi C, Savarino V, et al. Application of the platelet count/ spleen diameter ratio to rule out the presence of oesophageal varices in patients with cirrhosis: a validation study based on follow-up. Dig Liver Dis 2005; 37: 779-85.

  12. Giannini EG, Zaman A, Kreil A, Floreani A, Dulbecco P, Testa E, Sohaey R, et al. Platelet count/spleen diameter ratio for the noninvasive diagnosis of esophageal varices: results of a multicenter, prospective, validation study. Am J Gastroenterol 2006; 101: 2511-9.

  13. Barrera F, Riquelme A, Soza A, Contreras A, Barrios G, Padilla O, Viviani P, et al. Platelet count/spleen diameter ratio for non-invasive prediction of high risk esophageal varices in cirrhotic patients. Ann Hepatol 2009; 8: 325-30.

  14. Mattos AZ, Mattos AA, Vianna FF, Musskopf MI, Pereira- Lima JC, Maciel AC. Platelet count/spleen diameter ratio: analysis of its capacity as a predictor of the existence of esophageal varices. Arq Gastroenterol 2010; 47: 275-8.

  15. Chawla S, Katz A, Attar BM, Gupta A, Sandhu DS, Agarwal R. Platelet count/spleen diameter ratio to predict the presence of esophageal varices in patients with cirrhosis: a systematic review. Eur J Gastroenterol Hepatol 2012; 24: 431-6.

  16. Ying L, Lin X, Xie ZL, Hu YP, Shi KQ. Performance of platelet count/spleen diameter ratio for diagnosis of esophageal varices in cirrhosis: a meta-analysis. Dig Dis Sci 2012; 57: 1672-81.

  17. Wai CT, Greenson JK, Fontana RJ, Kalbfleisch JD, Marrero JA, Conjeevaram HS, Lok AS. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology 2003: 38: 518-26.

  18. Passaia A Jr, Borderie D, Bernard D, Scatton O, Calmus Y, Conti F. APRI and FIB-4 Scores Are Useful After Liver Transplantation Independently of Etiology. Transplant Proc 2009; 41: 679-81.

  19. Castéra L, Le Bail B, Roudot-Thoraval F, Bernard PH, Foucher J, Merrouche W, Couzigou P, et al. Early detection in routine clinical practice of cirrhosis and oesophageal varices in chronic hepatitis C: comparison of transient elastography (FibroScan) with standard laboratory tests and non-invasive scores. J Hepatol 2009; 50: 59-68.

  20. Testa R, Testa E, Giannini E, Borro P, Milazzo S, Isola L, Ceppa P, et al. Noninvasive ratio indexes to evaluate fibrosis staging in chronic hepatitis C: role of platelet count/spleen diameter ratio index. J Intern Med 2006; 260: 142-50.

  21. Stefanescu H, Grigorescu M, Lupsor M, Maniu A, Crisan D, Procopet B, Feier D, et al. A new and simple algorithm for the noninvasive assessment of esophageal varices in cirrhotic patients using serum fibrosis markers and transient elastography. J Gastrointestin Liver Dis 2011; 20: 57-64.

  22. Wang JH, Chuah SK, Lu SN, Hung CH, Chen CH, Kee KM, Chang KC, et al. Transient elastography and simple blood markers in the diagnosis of esophageal varices for compensated patients with hepatitis B virus-related cirrhosis. J Gastroenterol Hepatol 2012; 27: 1213-8.

  23. Sanyal AJ, Fontana RJ, Di Bisceglie AM, Everhart JE, Doherty MC, Everson GT, Donovan JA, et al. The prevalence and risk factors associated with esophageal varices in subjects with hepatitis C and advanced fibrosis. Gastrointest Endosc 2006; 64: 855-64.

  24. Tafarel JR, Tolentino LHL, Correa LM, Bonilha DR, Piauilino P, Martins FP, Rodrigues RA, et al. Prediction of esophageal varices in hepatic cirrhosis by noninvasive markers. Eur J Gastroenterol Hepatol 2011; 23: 754-8.




2020     |     www.medigraphic.com