Background: Hepatic venous pressure gradient (HVPG) is a prognostic marker in cirrhosis, but is invasive. There is a need to validate a noninvasive marker to measure portal hypertension. Aspartate aminotransferase/platelet ratio index (APRI) is proposed as a good noninvasive estimator of hepatic fibrosis. Whether APRI could be used as noninvasive tool to measure portal hypertension has not been studied.
Aim: To correlate APRI with HVPG in patients with cirrhosis and to determine the diagnostic usefulness of the APRI in detection of high portal pressure.
Methods: APRI and HVPG were measured in consecutive patients of cirrhosis aged 18-75 years, with serum bilirubin <5 mg/dl, Child-Turcotte-Pugh (CTP) score ≤12, and without evidence of acute-on-chronic liver failure or flare.
Results: This study included 74 patients (median age 47 years, range 20-70 years; 57 males, (77%). The aetiology of cirrhosis was: viral 33 (45%), alcohol 10 (14%), and cryptogenic and others 31 (42%). The median HVPG was 16 mmHg (range 2-28 mmHg). The median APRI was 1.19 (range 0.17-7.92). There was significant correlation between HVPG and APRI (Spearman's rho 0.365; p = 0.001). The ROC curve to study the performance of APRI for predicting high portal pressure (HVPG >12 mmHg) had area under curve 0.716 (95% CI 0.574-0.858). An APRI of ≥1.09 had a sensitivity 66%, specificity 73%, positive predictive value 85%, negative predictive value 47%, and diagnostic accuracy 68% for predicting HVPG >12 mmHg.
Conclusions: APRI correlates fairly with HVPG in patients of cirrhosis. An APRI score of ≥1.09 seems to have an acceptable accuracy for prediction of high portal pressure. APRI is a fair, bedside, cost-effective parameter for diagnosis of high portal pressure in patients with cirrhosis.
Keywords: Cirrhosis; HVPG; noninvasive; platelets; portal hypertension; portal pressure.