Clinical Value of APRI and FIB-4 on Bleeding Risk and 30-Day Prognosis in Patients with Liver Cirrhosis Complicated with Esophagogastric Varices
Year: 2025
Type: article
Study design: Observational Study
Abstract: Objective: To assess the clinical utility of aspartate transaminase-to-platelet ratio index (APRI) and fibrosis-4 index (FIB-4) in predicting both the risk and 30-day prognosis of esophagogastric variceal bleeding (EGVB) in patients with liver cirrhosis. Methods: In this retrospective cohort study, 231 cirrhotic patients (92 with EGVB and 139 controls) were randomly allocated to derivation (n=162) and validation (n=69) cohorts (7:3 ratio). Independent predictors of EGVB were identified through multivariate regression analysis, and a nomogram model was developed. Model performance was evaluated through internal validation assessing discrimination (ROC analysis), calibration (calibration curves), and clinical utility (decision curve analysis). The bleeding cohort was stratified into non-survivors (n=31) and survivors (n=61), with multivariate COX regression and Kaplan-Meier analyses examining associations between APRI/FIB-4 and 30-day mortality. Results: APRI, FIB-4, and WBC emerged as independent EGVB risk factors ( P < 0.05). The nomogram model demonstrated excellent predictive performance (AUC=0.794), good calibration, and clinical applicability. Combined assessment of all three indicators yielded superior predictive value (AUC=0.750; 95% CI:0.672– 0.829) compared to individual markers. Multivariate COX analysis revealed progressively stronger associations between elevated APRI (HR=12.09) and FIB-4 (HR=12.53) with mortality risk ( P < 0.001). Kaplan-Meier analysis confirmed significantly reduced survival in patients exceeding high-risk thresholds (APRI≥ 10.27, FIB-4≥ 19.03; log-rank P < 0.001). Conclusion: APRI, FIB-4, and WBC serve as independent EGVB predictors. The developed nomogram provides an effective screening tool, while the identified high-risk thresholds (APRI≥ 10.27, FIB-4≥ 19.03) offer valuable clinical warning indicators, enabling improved early diagnosis and intervention strategies for EGVB. Keywords: liver cirrhosis, esophageal and gastric varices, gastrointestinal hemorrhage, APRI, FIB-4, nomogram
DOI: 10.2147/ijgm.s545850
Authors: Qiuhui Tian, Yu Liu, Qiumei Cao, Mingjing Cheng, Meixu Zhang, Fengying Zhu, Yukai He
Language: English
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,836
OpenAlex ID: W4414973111