Clinical value of predictive models based on liver stiffness measurement in predicting liver reserve function of compensated chronic liver disease

Table 1 Comparison of demographic and clinical characteristics of chronic liver disease patients in the training cohort and validation cohort

	Validation cohort, n = 132	Training cohort, n = 360	P value
Gender (male/female, n)	90/42	260/100	0.381
Age (yr)	54.84 ± 27.70	48.71 ± 13.34	0.001
Etiology			0.097
HBV	111	278
Others	21	82
HCC (n)	42	63	0.001
HB (g/dL)	14.28 ± 10.86	13.71 ± 2.16	0.346
PLT (× 109/L)	174.96 ± 83.93	170.95 ± 74.69	0.610
PT (s)	13.21 ± 1.66	12.84 ± 1.67	0.030
APTT (s)	33.28 ± 7.73	32.54 ± 6.14	0.273
INR	1.16 ± 0.16	1.09 ± 0.16	0.000
AST (U/L)	72.14 ± 78.19	86.16 ± 135.81	0.264
ALT (U/L)	106.35 ± 166.60	136.73 ± 247.37	0.192
ALB (g/L)	38.03 ± 5.22	40.03 ± 5.08	0.000
TBIL (μmol/L)	28.29 ± 31.05	19.94 ± 16.99	0.000
CHE (U/L)	6163.11 ± 2647.19	6748.44 ± 2127.44	0.015
ALP (U/L)	118.60 ± 95.93	179.64 ± 721.94	0.334
GGT (U/L)	128.91 ± 201.79	116.89 ± 188.75	0.539
GLO (g/L)	28.70 ± 4.81	29.02 ± 5.19	0.534
Cr (μmol/L)	65.36 ± 23.23	65.68 ± 15.38	0.860
MELD	8.14 ± 3.46	7.80 ± 2.56	0.241
ALBI	-2.36 ± 0.54	-2.60 ± 0.48	0.000
PTAR	0.31 ± 0.07	0.28 ± 0.07	0.000
ICGR15 (%)	11.55 ± 11.82	8.16 ± 8.56	0.000
LSM (kPa)	19.54 ± 18.28	16.34 ± 16.62	0.066

HBV: Hepatitis B virus; HCC: Hepatocellular carcinoma; HB: Hemoglobin; PLT: Platelet count; PT: Prothrombin time; APTT: Active prothrombin time; INR: International normalized ratio; AST: Aspartate transaminase; ALT: Alanine aminotransaminase; ALB: Albumin; TBIL: Total bilirubin; CHE: Cholinesterase; ALP: Alkaline phosphatase; GGT: Gamma-glutamyltransferase; GLO: Globulin; Cr: Creatinine; MELD: Model for end-stage liver disease; ALBI: Albumin-bilirubin grade; PTAR: Prothrombin time international normalized ratio to albumin ratio; ICGR15: Indocyanine green retention rate at 15 min; LSM: Liver stiffness measurement.

Table 2 Multivariate logistic stepwise regression analysis of indocyanine green retention rate at 15 min ≥ 10% in the training cohort

Variable	B	SE	Wald	P value	OR (95%CI)
LSM (kPa)	1.472	0.338	19.008	< 0.001	4.357 (2.248-8.445)
PTAR	1.265	0.335	14.260	< 0.001	3.544 (1.838-6.835)
Age (yr)	0.047	0.012	15.329	< 0.001	1.048 (1.024-1.073)
MELD	0.291	0.078	13.844	< 0.001	1.337 (1.147-1.558)
Constant	-7.600	1.022	55.302	< 0.001	0.007

LSM: Liver stiffness measurement; PTAR: Prothrombin time international normalized ratio to albumin ratio; MELD: Model for end-stage liver disease.

Table 3 Multivariate logistic stepwise regression analysis of indocyanine green retention rate at 15 min ≥ 20% in the training cohort

Variable	B	SE	Wald	P value	OR (95%CI)
LSM (kPa)	1.138	0.520	4.778	0.029	3.120 (1.125-8.656)
PTAR	1.260	0.521	5.825	0.016	3.524 (1.267-9.801)
Age (yr)	0.058	0.017	11.226	0.001	1.059 (1.024-1.096)
MELD	0.320	0.094	11.652	0.001	1.377 (1.146-1.655)
Constant	-9.750	-1.454	44.963	< 0.001	0.001

LSM: Liver stiffness measurement; PTAR: Prothrombin time international normalized ratio to albumin ratio; MELD: Model for end-stage liver disease.

Table 4 Comparison of the predictive performance of the new constructed models (mLPaM and sLPaM) and other models in the assessment of impaired liver reserve function in the training cohort

	AUC (95%CI)	Optimal cut-off	Sensitivity (%)	Specificity (%)	PPV (%)	NPV (%)	Accuracy (%)
mLPaM	0.855 (0.809-0.901)	0.135	91.3	66.4	36.09	97.35	70.68
MELD	0.752 (0.688-0.817)	7.662	80.0	61.4	31.25	93.33	54.75
ALBI	0.776 (0.717-0.835)	-2.557	76.3	67.9	37.67	91.85	69.90
PTAR	0.728 (0.664-0.791)	0.150	73.8	71.8	42.11	90.79	72.24
LSM (kPa)	0.733 (0.672-0.794)	1.50	78.8	67.9	37.67	92.86	70.05
sLPaM	0.872 (0.823-0.921)	0.046	96.8	64.6	14.83	99.69	66.53
MELD	0.786 (0.687-0.886)	9.380	71.0	85.2	35.45	96.25	83.74
ALBI	0.798 (0.706-0.890)	-2.220	64.5	87.4	39.81	95.01	84.78
PTAR	0.731 (0.644-0.818)	0.150	80.6	65.5	15.33	97.76	66.59
LSM (kPa)	0.706 (0.618-0.795)	1.50	80.6	60.6	12.79	97.76	61.94

MELD: Model for end-stage liver disease; ALBI: Albumin-bilirubin grade; PTAR: Prothrombin time international normalized ratio to albumin ratio; LSM: Liver stiffness measurement; AUC: Area under the cure; CI: Confidence interval; NPV: Negative predictive value; PPV: Positive predictive value; mLPaM: Mildly impaired liver reserve function model; sLPaM: Severely impaired liver reserve function model.

Table 5 Comparison of the predictive performance of the new constructed models (mLPaM and sLPaM) and other models in the assessment of impaired liver reserve function in the prospective validation cohort

	AUC (95%CI)	Optimal cut-off	Sensitivity (%)	Specificity (%)	PPV (%)	NPV (%)	Accuracy (%)
mLPaM	0.869 (0.810-0.929)	0.240	89.1	74.4	60.85	93.86	78.94
MELD	0.729 (0.633-0.824)	9.743	43.5	96.5	93.65	59.01	67.74
ALBI	0.824 (0.749-0.900)	-2.315	78.3	76.7	63.78	87.09	77.25
PTAR	0.672 (0.580-0.765)	1.500	89.1	45.3	30.70	93.86	54.66
LSM (kPa)	0.782 (0.702-0.862)	1.500	91.3	65.1	49.93	95.15	72.33
sLPaM	0.876 (0.812-0.940)	0.073	92.9	68.3	49.94	95.15	72.33
MELD	0.803 (0.701-0.904)	9.187	64.3	85.6	61.54	87.00	79.98
ALBI	0.836 (0.743-0.929)	-1.897	71.4	88.5	67.44	90.27	84.22
PTAR	0.666 (0.566-0.767)	1.500	92.9	59.6	28.43	97.98	64.50
LSM (kPa)	0.743 (0.653-0.833)	1.500	92.9	55.8	25.37	97.98	60.96

MELD: Model for end-stage liver disease; ALBI: Albumin-bilirubin grade; PTAR: Prothrombin time international normalized ratio to albumin ratio; LSM: Liver stiffness measurement; AUC: Area under the cure; CI: Confidence interval; NPV: Negative predictive value; PPV: Positive predictive value; mLPaM: Mildly impaired liver reserve function model; sLPaM: Severely impaired liver reserve function model.