Splenic Arterial Pulsatility Index to Predict Hepatic Fibrosis in Hemodialysis Patients with Chronic Hepatitis C Virus Infection

The clinical utility of the splenic arterial pulsatility index (SAPI), a duplex Doppler ultrasonographic index, to predict the stage of hepatic fibrosis in hemodialysis patients with chronic hepatitis C virus (HCV) infection remains elusive. We conducted a retrospective, cross-sectional study to include 296 hemodialysis patients with HCV who underwent SAPI assessment and liver stiffness measurements (LSMs). The levels of SAPI were significantly associated with LSMs (Pearson correlation coefficient: 0.413, p < 0.001) and different stages of hepatic fibrosis as determined using LSMs (Spearman's rank correlation coefficient: 0.529, p < 0.001). The areas under receiver operating characteristics (AUROCs) of SAPI to predict the severity of hepatic fibrosis were 0.730 (95% CI: 0.671-0.789) for >= F1, 0.782 (95% CI: 0.730-0.834) for >= F2, 0.838 (95% CI: 0.781-0.894) for >= F3, and 0.851 (95% CI: 0.771-0.931) for F4. Furthermore, the AUROCs of SAPI were comparable to those of the fibrosis index based on four parameters (FIB-4) and superior to those of the aspartate transaminase (AST)-to-platelet ratio index (APRI). The positive predictive value (PPV) for >= F1 was 79.5% when the Youden index was set at 1.04, and the negative predictive values (NPVs) for >= F2, >= F3, and F4 were 79.8%, 92,6%, and 96.9%, respectively, when the maximal Youden indices were set at 1.06, 1.19, and 1.30. The diagnostic accuracies of SAPI with the maximal Youden index for a fibrosis stage of >= F1, >= F2, >= F3, and F4 were 69.6%, 67.2%, 75.0%, and 85.1%, respectively. In conclusion, SAPI can serve as a good noninvasive index in predicting the severity of hepatic fibrosis in hemodialysis patients with chronic HCV infection.

Automated summary

Retrospective study showed that the splenic arterial pulsatility index (SAPI) was closely associated with the severity of hepatic fibrosis in hemodialysis patients with chronic HCV infection. The diagnostic accuracy of SAPI was comparable to the fibrosis index based on four parameters (FIB-4) and superior to the aspartate transaminase (AST)-to-platelet ratio index (APRI). The positive predictive value (PPV) for >= F1 was 79.5%, and the negative predictive values (NPVs) for >= F2, >= F3, and F4 were 79.8%, 92.6%, and 96.9%, respectively, when the maximal Youden indices were used.