Value of international normalized ratio-to-platelet ratio in the diagnosis of liver fibrosis in patients with primary biliary cholangitis

Fangfang QIAO; Changyu SUN; Jiaqian HE; Shaoyu DONG; Jianying ZHANG

doi:10.3969/j.issn.1001-5256.2022.03.012

Volume 38 Issue 3

Mar. 2022

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Article Navigation > Journal of Clinical Hepatology > 2022 > 38(3): 553-557

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Value of international normalized ratio-to-platelet ratio in the diagnosis of liver fibrosis in patients with primary biliary cholangitis

DOI: 10.3969/j.issn.1001-5256.2022.03.012

1.
Department of Infectious Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
2.
School of Public Health, Zhengzhou University, Zhengzhou 450001, China

Research funding:

Sub-project of the National Science and Technology Major Project (2018ZX10302205-004)

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Corresponding author: SUN Changyu, changyu8188@163.com(ORCID:0000-0001-9993-8098)
Received Date: 2021-07-13
Accepted Date: 2021-08-16
Published Date: 2022-03-20

Abstract

Abstract

Objective To investigate the value of international standardized ratio-to-platelet ratio (INPR) versus aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis-4 (FIB-4) in the diagnosis of liver fibrosis in patients with primary cholangitis (PBC). Methods A retrospective analysis was performed for the patients who underwent liver biopsy and were diagnosed with PBC in The First Affiliated Hospital of Zhengzhou University from October 2013 to March 2021. Scheuer score was used to systematically evaluate the degree of liver fibrosis (S0-S4 stage). According to the results of liver biopsy, the degree of liver fibrosis was classified as significant liver fibrosis (≥S2), progressive liver fibrosis (≥S3), and liver cirrhosis (S4). Related data including general information, liver function, routine blood test results, and blood coagulation were collected, and related formulas were used to calculate the values of the noninvasive serological models INPR, APRI, and FIB-4. The Kruskal-Wallis H test was used for comparison of continuous data between multiple groups, and the chi-square test was used for comparison of categorical data between multiple groups. A Spearman correlation analysis was used to evaluate the correlation between noninvasive models and liver fibrosis stage. The receiver operating characteristic (ROC) curve was used to evaluate the efficacy of the noninvasive serological models in the diagnosis of liver fibrosis degree, and the DeLong method was used for comparison of the area under the ROC curve (AUC). Results A total of 143 patients with PBC were enrolled in the study, among whom 4 had stage S0 liver fibrosis, 50 had stage S1 liver fibrosis, 46 had stage S2 liver fibrosis, 26 had stage S3 liver fibrosis, and 17 had stage S4 liver fibrosis. There was a significant difference in INPR value between the PBC patients with different liver fibrosis degrees (χ²=27.347, P < 0.001). INPR value gradually increased with the aggravation of liver fibrosis degree, and INPR was positively correlated with liver fibrosis degree (r=0.419, P < 0.01). The ROC curve analysis showed that INPR, APRI, and FIB-4 had an AUC of 0.691, 0.706, and 0.742, respectively, in the diagnosis of significant liver fibrosis (≥S2) in PBC patients, at the corresponding cut-off values of 0.63, 0.59, and 2.68, respectively. INPR, APRI, and FIB-4 had an AUC of 0.731, 0.675, and 0.756, respectively, in the diagnosis of progressive hepatic fibrosis (≥S3) in PBC patients, at the corresponding cut-off values of 0.64, 1.23, and 4.63, respectively. INPR, APRI, and FIB-4 had an AUC of 0.820, 0.786, and 0.818, respectively, in the diagnosis of liver cirrhosis (S4) in PBC patients, at the corresponding cut-off values of 0.95, 1.26, and 4.63, respectively. In the evaluation of significant liver fibrosis, progressive liver fibrosis, and liver cirrhosis, there was no significant difference in AUC between INPR and APRI/FIB-4 (all P > 0.05). Conclusion INPR is a simple and accurate noninvasive model for the evaluation of liver fibrosis and has a certain value in the diagnosis of liver fibrosis in PBC.
- Liver Cirrhosis,
- Cholangitis,
- Diagnosis

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References

[1]	Chinese Society of Hepatology, Chinese Medical Association; Chinese Society of Gastroenterology, Chinese Medical Association; Chinese Society of Infectious Diseases, Chinese Medical Association. Consensus on the diagnosis and management of primary biliary cirrhosis (cholangitis)(2015)[J]. J Clin Hepatol, 2015, 31(12): 1980-1988. DOI: 10.3969/j.issn.1001-5256.2015.12.004. 中华医学会肝病学分会, 中华医学会消化病学分会, 中华医学会感染病学分会. 原发性胆汁性肝硬化(又名原发性胆汁性胆管炎)诊断和治疗共识(2015)[J]. 临床肝胆病杂志, 2015, 31(12): 1980-1988. DOI: 10.3969/j.issn.1001-5256.2015.12.004.
[2]	LIU X, LIU YP, GAO XS, et al. Progress on dyslipidemia in primary biliary cholangitis[J/CD]. Chin J Liver Dis (Electronic Version), 2020, 12(3): 17-22. DOI: 10.3969/j.issn.1674-7380.2020.03.004. 刘晓, 刘亚平, 高学松, 等. 原发性胆汁性胆管炎合并血脂异常研究进展[J/CD]. 中国肝脏病杂志(电子版), 2020, 12(3): 17-22. DOI: 10.3969/j.issn.1674-7380.2020.03.004.
[3]	CORPECHOT C. Utility of noninvasive markers of fibrosis in cholestatic liver diseases[J]. Clin Liver Dis, 2016, 20(1): 143-158. DOI: 10.1016/j.cld.2015.08.013.
[4]	JIANG M, YAN X, SONG X, et al. Total bile acid to platelet ratio: A noninvasive index for predicting liver fibrosis in primary biliary cholangitis[J]. Medicine (Baltimore), 2020, 99(22): e20502. DOI: 10.1097/MD.0000000000020502.
[5]	TAKAKI S, KAWAKAMI Y, MIYAKI D, et al. Non-invasive liver fibrosis score calculated by combination of virtual touch tissue quantification and serum liver functional tests in chronic hepatitis C patients[J]. Hepatol Res, 2014, 44(3): 280-287. DOI: 10.1111/hepr.12129.
[6]	DING R, ZHENG J, HUANG D, et al. INR-to-platelet ratio (INPR) as a novel noninvasive index for predicting liver fibrosis in chronic hepatitis B[J]. Int J Med Sci, 2021, 18(5): 1159-1166. DOI: 10.7150/ijms.51799.
[7]	LINDOR KD, BOWLUS CL, BOYER J, et al. Primary biliary cholangitis: 2018 Practice Guidance from the American Association for the Study of Liver Diseases[J]. Hepatology, 2019, 69(1): 394-419. DOI: 10.1002/hep.30145.
[8]	ROLL J, BOYER JL, BARRY D, et al. The prognostic importance of clinical and histologic features in asymptomatic and symptomatic primary biliary cirrhosis[J]. N Engl J Med, 1983, 308(1): 1-7. DOI: 10.1056/NEJM198301063080101.
[9]	CHRISTENSEN E, NEUBERGER J, CROWE J, et al. Beneficial effect of azathioprine and prediction of prognosis in primary biliary cirrhosis. Final results of an international trial[J]. Gastroenterology, 1985, 89(5): 1084-1091. DOI: 10.1016/0016-5085(85)90213-6.
[10]	LAMMERS WJ, KOWDLEY KV, van BUUREN HR. Predicting outcome in primary biliary cirrhosis[J]. Ann Hepatol, 2014, 13(4): 316-326.
[11]	MEHTA SH, LAU B, AFDHAL NH, et al. Exceeding the limits of liver histology markers[J]. J Hepatol, 2009, 50(1): 36-41. DOI: 10.1016/j.jhep.2008.07.039.
[12]	SCHLICHTING P, HØLUND B, POULSEN H. Liver biopsy in chronic aggressive hepatitis. Diagnostic reproducibility in relation to size of specimen[J]. Scand J Gastroenterol, 1983, 18(1): 27-32. DOI: 10.3109/00365528309181554.
[13]	CHENG DY, LI B, JI SB, et al. Application of transient elastography in noninvasive diagnosis of liver fibrosis[J/CD]. Chin J Liver Dis: Electronic Edition, 2021, 13(4): 9-13. DOI: 10.3969/j.issn.1674-7380.2021.04.003. 程丹颖, 李贲, 纪世博, 等. 瞬时弹性成像技术在肝纤维化无创诊断中的应用[J/CD]. 中国肝脏病杂志(电子版), 2021, 13(4): 9-13. DOI: 10.3969/j.issn.1674-7380.2021.04.003.
[14]	QIU LX, LIANG S, FAN ZP, et al. Value of FibroScan in the diagnosis of progressive liver fibrosis in patients with chronic hepatitis C and related influencing factors[J]. J Clin Hepatol, 2019, 35(9): 1950-1953. DOI: 10.3969/j.issn.1001-5256.2019.09.013. 仇丽霞, 梁珊, 范作鹏, 等. FibroScan对慢性丙型肝炎进展期肝纤维化的诊断价值及其影响因素[J]. 临床肝胆病杂志, 2019, 35(9): 1950-1953. DOI: 10.3969/j.issn.1001-5256.2019.09.013.
[15]	BASHOUR FN, TERAN JC, MULLEN KD. Prevalence of peripheral blood cytopenias (hypersplenism) in patients with nonalcoholic chronic liver disease[J]. Am J Gastroenterol, 2000, 95(10): 2936-2939. DOI: 10.1111/j.1572-0241.2000.02325.x.
[16]	WRIGHT M, GOLDIN R, FABRE A, et al. Measurement and determinants of the natural history of liver fibrosis in hepatitis C virus infection: A cross sectional and longitudinal study[J]. Gut, 2003, 52(4): 574-579. DOI: 10.1136/gut.52.4.574.
[17]	LIANG XE, DAI L, YANG SL, et al. Combining routine markers improves the accuracy of transient elastography for hepatitis B cirrhosis detection[J]. Dig Liver Dis, 2016, 48(5): 512-518. DOI: 10.1016/j.dld.2016.02.002.
[18]	WANG H, XU H, WANG X, et al. Red blood cell distribution width to platelet ratio is related to histologic severity of primary biliary cirrhosis[J]. Medicine (Baltimore), 2016, 95(11): e3114. DOI: 10.1097/MD.0000000000003114.
[19]	MA JL, WANG R, ZHANG FK, et al. A noninvasive diagnostic model of liver fibrosis using serum markers in primary biliary cirrhosis[J]. Chin J Intern Med, 2012, 51(8): 618-622. DOI: 10.3760/cma.j.issn.0578-1426.2012.08.011. 马佳丽, 王蕊, 张福奎, 等. 原发性胆汁性肝硬化无创性肝纤维化诊断模型的建立[J]. 中华内科杂志, 2012, 51(8): 618-622. DOI: 10.3760/cma.j.issn.0578-1426.2012.08.011.
[20]	JOSHITA S, UMEMURA T, OTA M, et al. AST/platelet ratio index associates with progression to hepatic failure and correlates with histological fibrosis stage in Japanese patients with primary biliary cirrhosis[J]. J Hepatol, 2014, 61(6): 1443-1445. DOI: 10.1016/j.jhep.2014.07.036.

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Value of international normalized ratio-to-platelet ratio in the diagnosis of liver fibrosis in patients with primary biliary cholangitis

DOI: 10.3969/j.issn.1001-5256.2022.03.012

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