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The Impact of Non-Invasive Scores and Hemogram-Derived Ratios in Differentiating Chronic Liver Disease from Cirrhosis
Abdulrahman Ismaiel1, Evrard Katell2, Daniel-Corneliu Leucuta3
12nd Department of Internal Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania.
Insights
This study shows that non-invasive scores like the Lok index, King score, and Fibrosis index can accurately differentiate chronic liver disease (CLD) from cirrhosis. These markers, along with neutrophil-to-lymphocyte ratio (NLR), aid in assessing liver disease severity.
Area of Science:
- Hepatology
- Biomarkers
- Diagnostic Tools
Background:
- Chronic liver disease (CLD) is a significant global health issue, with cirrhosis and liver cancer causing substantial mortality.
- Etiological factors include metabolic disorders, alcohol, and viral hepatitis, increasing CLD prevalence worldwide.
- Non-invasive biomarkers and scoring systems are crucial for assessing liver disease severity and distinguishing CLD from cirrhosis.
Purpose of the Study:
- To evaluate the utility of various non-invasive biomarkers and scoring systems in differentiating CLD from cirrhosis.
- To assess the diagnostic accuracy of hemogram-derived ratios in liver disease staging.
- To identify reliable markers for improved risk stratification in patients with CLD.
Main Methods:
- Retrospective observational study of 250 adult patients with CLD or cirrhosis.
- Inclusion criteria: patients diagnosed with cirrhosis or CLD of viral, autoimmune, or PBC etiology.
- Evaluation of non-invasive biomarkers, scores (APRI, FIB-4, NFS, Lok index, King score, Fibrosis index), and hemogram-derived ratios (NLR); statistical and ROC curve analysis.
Main Results:
- Cirrhosis patients (54.8%) exhibited lower hemoglobin, platelets, albumin, and higher liver enzymes and INR compared to CLD patients (45.2%).
- Non-invasive scores (APRI, FIB-4, NFS) and NLR were significantly higher in the cirrhosis group.
- The Lok index (AUC 0.89), King score (AUC 0.864), and Fibrosis index (AUC 0.856) showed high discriminatory power between CLD and cirrhosis.
Conclusions:
- Non-invasive biomarkers and scoring systems effectively differentiate CLD from cirrhosis.
- The Lok index, King score, and Fibrosis index demonstrate excellent diagnostic accuracy.
- Hemogram-derived ratios like NLR provide insights into systemic inflammation in progressive liver disease, supporting clinical integration for risk stratification.
Abstract:
Background: Chronic liver disease (CLD) is a major global health concern, contributing significantly to morbidity and mortality. Cirrhosis and liver cancer are the leading causes of liver-related deaths, with various etiological factors, such as metabolic disorders and alcohol-related and viral hepatitis, driving its global prevalence. Non-invasive biomarkers and scoring systems have emerged as key tools for assessing liver disease severity and differentiating CLD from cirrhosis. This study evaluates biomarkers and non-invasive scores and their utility in distinguishing CLD from cirrhosis. Methods: This retrospective observational study included 250 adult patients hospitalized between January 2021 and December 2023 at Cluj County Emergency Clinical Hospital, Romania. Patients were diagnosed with either cirrhosis or CLD of viral, autoimmune, or primary biliary cholangitis (PBC) etiology. Non-invasive biomarkers, scores, and various hemogram-derived ratios were evaluated. Statistical analysis involved descriptive statistics, comparative tests, and receiver operating characteristic (ROC) curve analysis. Results: Among the 250 patients, 137 had liver cirrhosis (54.8%) and 113 had CLD without cirrhosis (45.2%). Significant differences were observed in laboratory parameters, with cirrhosis patients showing lower hemoglobin, platelet count, and albumin levels alongside higher liver enzymes and INR values. Non-invasive scores such as APRI, FIB-4, and NFS demonstrated higher values in the cirrhosis group, indicating more advanced liver damage. Hemogram-derived ratios, particularly the neutrophil-to-lymphocyte ratio (NLR), were higher in cirrhosis patients. ROC analysis revealed that the Lok index had the highest discriminatory power (AUC 0.89), followed by the King score (AUC 0.864) and the Fibrosis index (AUC 0.856), which effectively distinguished cirrhosis from CLD. Conclusions: This study underscores the utility of non-invasive biomarkers and scoring systems in differentiating CLD from cirrhosis. The Lok index, King score, and Fibrosis index demonstrated excellent diagnostic accuracy, while hemogram-derived ratios, such as NLR, offer insights into systemic inflammation associated with liver disease progression. These findings support the integration of non-invasive markers into clinical practice for improved risk stratification and management of liver diseases.
