Clinical value of spleen acoustic radiation force impulse, aspartate aminotransferase-to-platelet ratio index, and aspartate aminotransferase/alanine aminotransferase ratio in predicting esophageal varices in patients with liver cirrhosis

Objective To investigate the spleen stiffness of patients with chronic hepatitis and liver cirrhosis by spleen acoustic radiation force impulse ( ARFI) , aspartate aminotransferase-to-platelet ratio index ( APRI) , and aspartate aminotransferase/alanine aminotransferase ratio ( AAR) , as well as the clinical value of these three noninvasive techniques in predicting esophageal varices ( EV) in patients with liver cirrhosis. Methods A total of 247 patients with chronic hepatitis and liver cirrhosis were enrolled, and ARFI was used to measure real-time spleen stiffness. APRI and AAR were calculated. Gastroscopy was performed within one week before and after measurement to clarify the degree of EV. With the results of gastroscopy as the gold standard, the receiver operating characteristic ( ROC) curve was used to compare the clinical value of spleen ARFI value, APRI, and AAR in the diagnosis of EV in patients with liver cirrhosis. The t-test was used for comparison of continuous data between two groups. Results There were significant differences between the EV group ( n = 169) and the non-EV group ( n = 78) in spleen ARFI stiffness ( 3. 64 ± 0. 53 m/s vs 2. 97 ± 0. 65 m/s, t =-7. 93, P < 0. 001) , APRI ( 0. 87 ±0. 91 vs 0. 52 ± 0. 80, t =-2. 90, P = 0. 004) , and AAR ( 1. 54 ± 0. 67 vs 1. 29 ± 0. 55, t =-2. 93, P = 0. 004) . Spleen ARFI, APRI, and AAR had an area under the ROC curve of 0. 80, 0. 72, and 0. 63, respectively, in predicting EV in patients with liver cirrhosis; there was a significant difference between spleen ARFI stiffness and AAR ( P = 0. 005) , while there was no significant difference between spleen ARFI stiffness and APRI ( P = 0. 10) . Conclusion ARFI is a real-time ultrasound elastography technique, and compared with APRI and AAR, spleen stiffness measured by ARFI can predict EV in patients with chronic hepatitis and liver cirrhosis more accurately and noninvasively and thus holds promise for clinical application.