The diagnostic value of non-invasive diagnostic indicators such as liver hardness-spleen diameter/platelet ratio (LSPS) for predicting high-risk oesophageal varicose veins (HERV) in liver cirrhotic patients

Abstract

Abstract: Objective To evaluate the diagnostic value of non-invasive diagnostic indicators such as liver hardness-spleen diameter/platelet ratio (LSPS) in predicting patients with high-risk oesophageal varicose veins (HERV) in liver cirrhosis.Methods A total of 143 patients with liver cirrhosis who were hospitalized in the Affiliated Hospital of Traditional Chinese Medicine of Xinjiang Medical University from March 2022 to March 2023 were enrolled in this study. Their clinical data and serological indicators were collected. Electronic gastroscopy, abdominal ultrasound and liver instantaneous elastic imaging (LSM) were conducted at the same time in all patients. Taking gastroscopy as the gold standard, the patients are divided into a high-risk varicose and a non-high-risk varicose groups. LSPS, varicose risk score, PH score, FIB-4, APRI and GPR were calculated, and the working characteristics (ROC) curve of the subjects were drawn to evaluate the efficacy of these non-invasive models for the diagnosis of HERV.Results (1) Within the 143 cases included in this study, 63 patients had high-risk varicose veins and 80 patients had non-high-risk varicose veins. (2) When compared with the non-high-risk varicose veins group, the serological indicators, imaging indicators (portal vein diameter, spleen thicknes, spleen length) and liver function scores (CTP, MELD), the non-invasive diagnostic indicators such as LSPS, PH score, risk score of varicose veins, LSM, FIB-4, APRI and GPR of patients in the high-risk varicose group were significantly different (P<0.05). (3) The area under the curve (AUC) for the non-invasive diagnostic index is LSPS: 0.865 (95%CI 0.806～0.923), PH score: 0.856 (95%CI 0.796～0.917), static pulse risk score: 0.855 (95%CI 0.795～0.916), FIB-4:0.817 (95%CI 0.744～0.890), APRI: 0.766 (95%CI 0.686～0.846), CTP score: 0.761 (95%CI 0.680～0.843), LSM: 0.740 (95%CI 0.660～0.821), MELD score: 0.693 (95%CI 0.607～0.780) and GPR: 0.667 (95%CI 0.575～0.758). (4) Compared with the joint index of non-invasive diagnosis and the individual index, the diagnostic efficacy of HERV was not significantly improved.Conclusion LSPS has good diagnostic value for HERV, which is better than other individual non-invasive diagnostic indicators and joint models.

Key words: Liver hardness-spleen diameter/platelet ratio, Non-invasive diagnostic indicators, High-risk oesophageal varicose veins of liver cirrhosis, Diagnostic value

SUN Wei, YU Hong, NIU Li-na, LONG Qiang, DOU Jing, LIU Yun-xiao, GUO Feng, WANG Xiao-zhong. The diagnostic value of non-invasive diagnostic indicators such as liver hardness-spleen diameter/platelet ratio (LSPS) for predicting high-risk oesophageal varicose veins (HERV) in liver cirrhotic patients[J]. Chinese Hepatolgy, 2025, 30(3): 310-315.

References

[1] Simonetto D A, Liu M, Kamath P S. Portal hypertension and related complications: diagnosis and management[J]. Mayo Clin Proc, 2019, 94(4): 714-726.
[2] Park M K, Lee Y B. Diagnosis and management of esophageal and gastric variceal bleeding: focused on 2019 KASL clinical practice guidelines for liver cirrhosis[J]. Korean J. Gastroenterol, 2021, 78(3): 152-160.
[3] Zuckerman M J, Elhanafi S, Mendoza Ladd A. Endoscopic treatment of esophageal varices[J]. Clinics in Liver Disease, 2022, 26(1): 21-37.
[4] Douglas Q Z. Variceal bleeds in patients with cirrhosis[J]. Crit. Care Nurs. Clin. North Am., 2022, 34(3): 303-309.
[5] Lesmana C R A, Raharjo M, Gani R A. Managing liver cirrhotic complications: overview of esophageal and gastric varices[J]. Clin Mol Hepatol, 2020, 26(4): 444-460.
[6] 徐小元, 丁惠国, 李文刚, 等. 肝硬化诊治指南[J]. 临床肝胆病杂志, 2019, 35(11): 2408-2425.
[7] De franchis R, Bosch J, Garcia-Tsao G, et al. Baveno VII - renewing consensus in portal hypertension[J]. J Hepatol, 2022, 76(4): 959-974.
[8] Gaete MI, Díaz L A, Arenas A, et al. Baveno VI and expanded Baveno VI criteria successfully predicts the absence of high-risk gastro-oesophageal varices in a Chilean cohort[J]. Liver Int, 2020, 40(6): 1427-1434.
[9] Zhang X, Song J, Zhang Y, et al. Baveno VII algorithm outperformed other models in ruling out high-risk varices in individuals with HBV-related cirrhosis[J]. J Hepatol, 2023, 78(3): 574-583.
[10] Xuan J, Shi Z. Shear wave elastography measured liver stiffness-spleen size-to-platelet ratio for the prediction of high-risk oesophageal varices: a meta-analysis[J]. Eur J Gastroenterol Hepatol, 2023, 35(7): 753-760.
[11] Mnif L, Hachicha S, Abid F, et al. Role of splenic and hepatic stiffness in predicting esophageal varices[J]. Tunis Med, 2021, 99(5): 544-551.
[12] Cunningham M, Chehr G, Cerocchi O, et al. Non-invasive predictors of varices in non-cirrhotic portal hypertension[J]. J Hepatol, 2018, 68: S749.
[13] 周佳美, 班志超, 李艳, 等. 肝硬度×脾脏直径/血小板评分对肝硬化食管静脉曲张的预测价值[J]. 临床肝胆病杂志, 2018, 34(11): 2341-2344.
[14] De franchis R. Expanding consensus in portal hypertension: report of the Baveno VI Consensus Workshop: stratifying risk and individualizing care for portal hypertension[J]. J Hepatol, 2015, 63(3): 743-752.
[15] 刘积庆, 孟繁坤, 丁惠国, 等. 脾脏硬度预测肝硬化患者门静脉高压及其并发症的研究现状[J]. 临床肝胆病杂志, 2023, 39(5): 1184-1190.
[16] 朱宇莉, 丁红, 付甜甜, 等. 二维剪切波弹性成像技术联合APRI指数预测中重度食管胃底静脉曲张的临床价值[J]. 中国超声医学杂志, 2021, 37(2): 150-152.
[17] 中华医学会超声医学分会, 中国门静脉高压联盟. 中国超声弹性成像技术诊断肝硬化门静脉高压专家共识(2023版)[J]. 中华医学杂志, 2023, 103(32): 2480-2494.
[18] Garcovich M, Di stasio E, Zocco M A, et al. Assessing baveno VI criteria with liver stiffness measured using a new point-shear wave elastography technique (BAVElastPQ study)[J]. Liver Int, 2020, 40(8): 1952-1960.
[19] Lucchina N, Recaldini C, Macchi M, et al. Point shear wave elastography of the spleen: its role in patients with portal hypertension[J]. Ultrasound Med Biol, 2018, 44(4): 771-778.
[20] 李德钊, 李健, 郭晓林. 白蛋白-胆红素评分对肝硬化食管胃静脉曲张出血患者预后的预测价值[J]. 临床肝胆病杂志, 2021, 37(5): 1085-1090.
[21] 邓泽平, 覃山羽, 姜海行. 辽宁评分与多种无创评分系统预测肝硬化患者高危食管静脉曲张及出血或再出血的价值比较[J]. 中华消化内镜杂志, 2022, 39(5): 388-393.