Accuracy of Ultrasound and Noninvasive Markers of Fibrosis to Identify Patients with Cirrhosis

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background: Accurate identification of patients with cirrhosis using noninvasive markers of fibrosis is useful for esophageal varices and hepatocellular carcinoma surveillance programs. The aims of our study were to characterize the accuracy of ultrasonography, AST-to-platelet ratio index (APRI), and FIB-4 as noninvasive markers to identify the presence of cirrhosis. Methods: We conducted a retrospective cohort study of patients who underwent liver biopsy at a large urban safety-net institution between November 2008 and July 2011. The sensitivity, specificity, positive predictive value (PPV), negative predictive value, and overall accuracy using receiver operator characteristic curve analysis for the detection of cirrhosis were calculated for each noninvasive marker. Results: Liver biopsy was performed in 388 patients, of whom 93 (24.0 %) had cirrhosis. C-statistics for APRI and FIB-4 predicting the presence of cirrhosis were 0.68 (95 % CI 0.63–0.74) and 0.73 (95 % CI 0.68–0.78), respectively. The c-statistic for a nodular appearance on ultrasound was 0.78 (95 % CI 0.72–0.83). The PPV of a shrunken nodular-appearing liver was 64.8 %; however, PPV was significantly higher in the subset with a cirrhotic-appearing liver and signs of portal hypertension (PPV 83.6 %, p = 0.01) as well as in the subset with a noninvasive fibrosis marker also suggesting cirrhosis (PPV 77.8 %, p < 0.001). Conclusion: Serum and imaging noninvasive markers of fibrosis may have insufficient accuracy when used in isolation; however, a combination of markers may allow sufficient accuracy to systematically identify patients with cirrhosis.

Original languageEnglish (US)
Pages (from-to)1841-1847
Number of pages7
JournalDigestive Diseases and Sciences
Volume60
Issue number6
DOIs
StatePublished - Jun 5 2015

Fingerprint

Fibrosis
Liver
Blood Platelets
Biopsy
Esophageal and Gastric Varices
Portal Hypertension
Hepatocellular Carcinoma
Ultrasonography
Cohort Studies
Retrospective Studies
Safety
Sensitivity and Specificity
Serum

Keywords

  • APRI
  • Cirrhosis
  • Noninvasive markers of fibrosis
  • Ultrasound

ASJC Scopus subject areas

  • Gastroenterology
  • Physiology

Cite this

Accuracy of Ultrasound and Noninvasive Markers of Fibrosis to Identify Patients with Cirrhosis. / Martin, Jason; Khatri, Gaurav; Gopal, Purva; Singal, Amit G.

In: Digestive Diseases and Sciences, Vol. 60, No. 6, 05.06.2015, p. 1841-1847.

Research output: Contribution to journalArticle

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abstract = "Background: Accurate identification of patients with cirrhosis using noninvasive markers of fibrosis is useful for esophageal varices and hepatocellular carcinoma surveillance programs. The aims of our study were to characterize the accuracy of ultrasonography, AST-to-platelet ratio index (APRI), and FIB-4 as noninvasive markers to identify the presence of cirrhosis. Methods: We conducted a retrospective cohort study of patients who underwent liver biopsy at a large urban safety-net institution between November 2008 and July 2011. The sensitivity, specificity, positive predictive value (PPV), negative predictive value, and overall accuracy using receiver operator characteristic curve analysis for the detection of cirrhosis were calculated for each noninvasive marker. Results: Liver biopsy was performed in 388 patients, of whom 93 (24.0 {\%}) had cirrhosis. C-statistics for APRI and FIB-4 predicting the presence of cirrhosis were 0.68 (95 {\%} CI 0.63–0.74) and 0.73 (95 {\%} CI 0.68–0.78), respectively. The c-statistic for a nodular appearance on ultrasound was 0.78 (95 {\%} CI 0.72–0.83). The PPV of a shrunken nodular-appearing liver was 64.8 {\%}; however, PPV was significantly higher in the subset with a cirrhotic-appearing liver and signs of portal hypertension (PPV 83.6 {\%}, p = 0.01) as well as in the subset with a noninvasive fibrosis marker also suggesting cirrhosis (PPV 77.8 {\%}, p < 0.001). Conclusion: Serum and imaging noninvasive markers of fibrosis may have insufficient accuracy when used in isolation; however, a combination of markers may allow sufficient accuracy to systematically identify patients with cirrhosis.",
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AU - Khatri, Gaurav

AU - Gopal, Purva

AU - Singal, Amit G.

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N2 - Background: Accurate identification of patients with cirrhosis using noninvasive markers of fibrosis is useful for esophageal varices and hepatocellular carcinoma surveillance programs. The aims of our study were to characterize the accuracy of ultrasonography, AST-to-platelet ratio index (APRI), and FIB-4 as noninvasive markers to identify the presence of cirrhosis. Methods: We conducted a retrospective cohort study of patients who underwent liver biopsy at a large urban safety-net institution between November 2008 and July 2011. The sensitivity, specificity, positive predictive value (PPV), negative predictive value, and overall accuracy using receiver operator characteristic curve analysis for the detection of cirrhosis were calculated for each noninvasive marker. Results: Liver biopsy was performed in 388 patients, of whom 93 (24.0 %) had cirrhosis. C-statistics for APRI and FIB-4 predicting the presence of cirrhosis were 0.68 (95 % CI 0.63–0.74) and 0.73 (95 % CI 0.68–0.78), respectively. The c-statistic for a nodular appearance on ultrasound was 0.78 (95 % CI 0.72–0.83). The PPV of a shrunken nodular-appearing liver was 64.8 %; however, PPV was significantly higher in the subset with a cirrhotic-appearing liver and signs of portal hypertension (PPV 83.6 %, p = 0.01) as well as in the subset with a noninvasive fibrosis marker also suggesting cirrhosis (PPV 77.8 %, p < 0.001). Conclusion: Serum and imaging noninvasive markers of fibrosis may have insufficient accuracy when used in isolation; however, a combination of markers may allow sufficient accuracy to systematically identify patients with cirrhosis.

AB - Background: Accurate identification of patients with cirrhosis using noninvasive markers of fibrosis is useful for esophageal varices and hepatocellular carcinoma surveillance programs. The aims of our study were to characterize the accuracy of ultrasonography, AST-to-platelet ratio index (APRI), and FIB-4 as noninvasive markers to identify the presence of cirrhosis. Methods: We conducted a retrospective cohort study of patients who underwent liver biopsy at a large urban safety-net institution between November 2008 and July 2011. The sensitivity, specificity, positive predictive value (PPV), negative predictive value, and overall accuracy using receiver operator characteristic curve analysis for the detection of cirrhosis were calculated for each noninvasive marker. Results: Liver biopsy was performed in 388 patients, of whom 93 (24.0 %) had cirrhosis. C-statistics for APRI and FIB-4 predicting the presence of cirrhosis were 0.68 (95 % CI 0.63–0.74) and 0.73 (95 % CI 0.68–0.78), respectively. The c-statistic for a nodular appearance on ultrasound was 0.78 (95 % CI 0.72–0.83). The PPV of a shrunken nodular-appearing liver was 64.8 %; however, PPV was significantly higher in the subset with a cirrhotic-appearing liver and signs of portal hypertension (PPV 83.6 %, p = 0.01) as well as in the subset with a noninvasive fibrosis marker also suggesting cirrhosis (PPV 77.8 %, p < 0.001). Conclusion: Serum and imaging noninvasive markers of fibrosis may have insufficient accuracy when used in isolation; however, a combination of markers may allow sufficient accuracy to systematically identify patients with cirrhosis.

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