Abstract:

Objective To evaluate the diagnostic value of non-invasive models for autoimmune cirrhosis with esophagogastric varices （EGV），and to provide the basis for the early diagnosis of autoimmune cirrhosis with EGV. Methods The retrospective collection of clinical data from 238 patients diagnosed with autoimmune cirrhosis was performed， and the patients divided into EGV group and non-EGV group according to whether complicated with EGV. The levels of alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， γ-glutamyltransferase （γ-GT）， platelet （PLT）， AST / PLT index （APRI）， fibrosis-4 index （FIB-4）， and AST/ALT ratio （AAR） of the patients in both groups were compared and the receiver operating characteristic （ROC） curve was plotted to calculate the area under the curve （AUC）， sensitivity， specificity， positive predictive value， and negative predictive value to evaluate the diagnostic values of various models for autoimmune cirrhosis with EGV. Results The levels of APRI， FIB-4， and ALT of the patients in EGV group were significantly higher than those in non-EGV group （P<0.01）， while the levels of PLT and AAR were significantly lower than those in non-EGV group （P<0.01）. In single indicator diagnostic model， ALT had the largest AUC of 0.645 （95% CI： 0.580－0.705， P<0.001）， the sensitivity was 93.75%， the specificity was 34.04%， the positive predictive value was 68.53%， and the negative predictive value was 78.05%. In multiple indicator combined models， the combined model of ALT+FIB-4+AAR+PLT had the largest AUC of 0.787 （95% CI： 0.730－0.838， P<0.001）， and the sensitivity was72.22%， the specificity was 73.40%， the positive predictive value was 80.62%， and the negative predictive value was 63.30%. Compared with ALT and ALT+FIB-4 models，the AUC of the combined models of ALT+FIB-4+AAR， ALT+FIB-4+AAR+PLT， and ALT+FIB-4+AAR+PLT+APRI had statistically significant differences （P<0.05）. However， there were no significant differences in AUC among the above three models （P>0.05）. Conclusion The combined detection of APRI， FIB-4， ALT， PLT， and AAR can improve the early diagnostic efficacy of autoimmune cirrhosis with EGV.

Key words: Autoimmunity, Liver cirrhosis, Esophagogastric fundus varices, Predictive modeling, Diagnostic value