Study On The Predictive Value Of LSPS,RDW And Four Indicators Of Hepatic Fibrosis For Esophageal Varices In Liver Cirrhosis

Background and ObjectiveLiver cirrhosis(LC)is a common stage of the progression of many chronic liver diseases,esophageal varices(EV)is one of the common complications of liver cirrhosis.Esophageal varices bleeding(EVB)has a high mortality rate and is one of the most serious complications of liver cirrhosis.Therefore,it is significant to improve the early diagnosis rate of EV and actively take preventive treatment for patients with severe varices and high risk of bleeding to reduce mortality.Gastroscopy is the gold standard for diagnosing EV,but as an invasive test,gastroscopy increases the risk of bleeding and anesthesia,and is more expensive,which leads to the decline of patients’ medical compliance.Therefore,scholars at home and abroad are actively seeking non-invasive indicators that have predictive value for EV.Blood platelet(PLT),spleen diameter(SD),liver stiffness measurement(LSM),red blood cell distribution width(RDW)and four indicators of hepatic fibrosis:hyaluronic acid(HA),laminin(LN),procollagen TypeⅢ N-terminal peptide(PⅢNP),Collagen Type IV(CIV)are widely used in clinic.The liver stiffness-spleen diameter-to-platelet ratio score(LSPS)obtained by LSM,SD,and PLT also has important significance.There are few studies on the predictive value of LSPS,RDW and four indicators of hepatic fibrosis for EV.The purpose of this study was to compare the differences of LSPS,RDW and four indicators of hepatic fibrosis in patients with different degree of EV,analyze the correlation between LSPS,RDW,four indicators of hepatic fibrosis and the degree of EV,and explore the predictive value of LSPS,RDW,four indicators of hepatic fibrosis for EV and severe EV.MethodsRetrospective analysis of the clinical data of liver cirrhosis from January 2018 to January 2020 in the First Affiliated Hospital of Zhengzhou University.General date,PLT,SD,LSM,RDW,HA,LN,PⅢNP,CIV were collected,LSPS were calculated.SPSS 21.0 was used for statistical analysis.The measurement date obeying normal distribution were expressed by mean ± standard deviation(x±s),median and inter-quartile range M[P25,P75]were used for non-normal distribution.The data of normal distribution were compared by t-test,one-way analysis of variance and LSD-t test.The data of non-normal distribution were compared by Mann-Whitney U test,Kruskal-Wallis test and Bonferroni test.Qualitative data were compared by χ2-test.Spearman rank correlation was used for correlation analysis.Draw the receiver operating characteristic curves(ROC),selected the best cutoff value that corresponding to the maximum sum of sensitivity and specificity,according to the area under the receiver operating characteristic curves(AUC)evaluated the accuracy of the prediction results.P<0.05 was statistically significant.Results1.Among 325 patients with liver cirrhosis,the average age was 54.10±11.65,and included 216 males and 109 females.The etiology of liver cirrhosis were:217 cases of HBV,43 cases of HCV,27 cases of primary biliary cholangitis,8 cases of autoimmune hepatitis,17 cases of alcoholic hepatitis,and 13 cases of other causes.2.In none EV group,mild EV group,moderate EV group and severe EV group,age and sex were no statistically significant(all P>0.05),PLT,RDW,HA,LN,PIIINP,CIV,SD,LSM and LSPS showed statistically significant(all P<0.05);PLT was negatively correlated with the degree of EV,RDW,HA,LN,PⅢNP,CⅣ,SD,LSM and LSPS were positively correlated with the degree of EV(all P<0.001);LSPS,LSM,SD,PLT were moderately correlated(r=0.670,r=0.635,r=0.515,r=-0.411),RDW,HA,LN,PⅢNP,CⅣ were weakly correlated(r=0.248,r=0.278,r=0.206,r=0.233,r=0.193).3.In none EV group and EV group,non-severe EV group and severe EV group,age and sex were no statistically significant(all P>0.05),PLT,RDW,HA,LN,PⅢNP,CⅣ,SD,LSM and LSPS showed statistically significant(all P<0.05);PLT of EV group and severe EV group was lower than that of none EV group and non-severe EV group;RDW,HA,LN,PⅢNP,CⅣ,SD,LSM and LSPS of EV group and severe EV group were higher than those of none EV group and non-severe EV group.4.The AUC of LSPS for predicting EV was 0.875,the best cutoff value was 3.868,the sensitivity was 77.5%and the specificity was 81.5%;the AUC of LSPS for predicting severe EV was 0.856,the best cutoff value was 5.095,the sensitivity was 87.1%and the specificity was 73.5%.5.The AUC of RDW for predicting EV was 0.613,the best cutoff value was 14.565%,the sensitivity was 77.9%and the specificity was 46.3%;the AUC of RDW for predicting severe EV was 0.629,the best cutoff value was 14.885%,the sensitivity was 79.4%and the specificity was 41.8%.6.The AUC of HA,LN,PⅢNP,CⅣ for predicting EV were 0.652,0.645,0.607,0.595,the best cutoff value were 336.493 ng/mL,142.239 ng/mL,16.996 ng/mL,81.190 ng/mL,the sensitivity were 63.8%,53.5%,46.9%,90.0%and the specificity were 64.8%,74.1%,75.9%,35.2%;the AUC of HA,LN,PⅢNP,CⅣ for predicting severe EV were 0.641,0.592,0.622,0.600,the best cutoff value were 610.114 ng/mL,194.143 ng/mL,16.996 ng/mL,87.429 ng/mL,the sensitivity were 53.5%,34.2%,56.1%,91.6%and the specificity were 77.6%,83.5%,68.8%,25.3%.Conclusions1.LSPS,RDW and four indicators of hepatic fibrosis were related to the degree of EV in liver cirrhosis,the levels of LSPS,RDW and four indicators of hepatic fibrosis increased with the increase of the degree of EV.2.LSPS had a high predictive value for EV and severe EV in liver cirrhosis,and it had certain guiding significance for the diagnosis and treatment of EV.3.RDW and four indicators of hepatic fibrosis had certain predictive value for EV and severe EV in liver cirrhosis,but the predictive value were low.