Observational Study
Copyright ©The Author(s) 2024.
World J Gastroenterol. Feb 21, 2024; 30(7): 685-704
Published online Feb 21, 2024. doi: 10.3748/wjg.v30.i7.685
Table 1 Demographic data of the study population (baseline)
Healthy subjects (n = 40)
cACLD patients (n = 150)
P value
Male [n (%)]23 (57.5)88 (58.7)NS1
Female [n (%)]17 (42.5)62 (41.3)NS1
Age (mean ± SD)57.10 ± 17.0363.15 ± 11.45NS2
Child-Pugh Grade A [n (%)]NA107 (71.3%)/
Child-Pugh Grade B [n (%)]NA43 (28.7%)/
1Chi-square test.
2Mann-Whitney U test.
Statistically significant differences (P < 0.05) are reported in bold. NA: Not-assessed (or not-appliable); NS: Not statistically significant; cACLD: Compensated advanced chronic liver disease.
Table 2 Anthropometric indexes of the study population (baseline)
Variables (mean ± SD)
Healthy subjects (n = 40)
cACLD patients (n = 150)
P value1
BMI (kg/m2)24.97 ± 2.1732.61 ± 23.94< 0.0001
WhR0.81 ± 0.051.56 ± 3.02< 0.0001
Systolic blood pressure (mm/Hg)115.3 ± 9.73130.7 ± 12.57< 0.0001
Diastolic blood pressure (mm/Hg)74.67 ± 10.4287.33 ± 8.580.003
1Mann-Whitney U test.
Statistically significant differences (P < 0.05) are reported in bold. BMI: Body mass index; WhR: Waist to hip ratio; cACLD: Compensated advanced chronic liver disease.
Table 3 Biochemical parameters of the study population (baseline)
Variables (mean ± SD)
Healthy subjects (n = 40)
cACLD patients (n = 150)
P value1
AST (IU/L)31.30 ± 10.1448.74 ± 54.09< 0.0001
ALT (IU/L)39.37 ± 17.5770.02 ± 15.05< 0.0001
Bilirubin (µmol/L)15.98 ± 1.7425.86 ± 7.53< 0.0001
PLT count (mm3)242.6 ± 42.76155.7 ± 61.56< 0.0001
RDW-CV (%)14.40 ± 2.2821.04 ± 15.20< 0.0001
RDW-SD (fL)40.19 ± 4.4856.27 ± 10.54< 0.0001
Albumin (g/L)44.2 ± 0.2926.35 ± 8.48< 0.0001
INR1.02 ± 0.381.78 ± 1.11NS
HOMA-IR1.77 ± 0.543.15 ± 1.52< 0.0001
Insulin (µu/mL)7.03 ± 1.5211.67 ± 3.259< 0.0001
FPG (mg/dL)100.7 ± 9.35120.9 ± 17.48< 0.0001
Total cholesterol (mg/dL)135.2 ± 42.07185.2 ± 44.12< 0.0001
HDL (mg/dL)95.93 ± 27.2942.37 ± 9.92< 0.0001
LDL (mg/dL)44.73 ± 9.67126.1 ± 39.78< 0.0001
Tryglicerides (mg/dL)109.5 ± 32.14150.6 ± 63.390.002
Creatinine (mg/dL)0.97 ± 0.231.48 ± 3.880.03
1Mann-Whitney U test.
Statistically significant differences (P < 0.05) are reported in bold. AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; PLT: Platelets count; CV: Coefficient Variation; RDW: Red-cell distribution width; INR: International normalized ratio; HOMA-IR: homeostasis model assessment for insulin resistance; NS: Not statistically significant; cACLD: Compensated advanced chronic liver disease.
Table 4 Non-invasive tools for liver disease severity assessment of the study population (baseline)
Variables (mean ± SD)
Healthy subjects (n = 40)
cACLD patients (n = 150)
P value
LSM (kPa)NA19.67 ± 3.39/
APRINA1.75 ± 0.28/
FIB-4NA3.11 ± 1.78/
ALBINA-2.378 ± 0.63/
ALBI-FIB-4NA1.44 ± 0.99/
Child-PughNA6.24 ± 1.23/
MELDNA7.74 ± 2.69/
RDW (fL)/PLT ratio0.17 ± 0.030.458 ± 0.27/
LSM: Liver stiffness measurement; APRI: Aspartate aminotransferase/platelet count ratio index; MELD: Model for End-stage Liver Disease; FIB-4: Fibrosis-4; NA: Not-assessed (or not-appliable); cACLD: Compensated advanced chronic liver disease.
Table 5 Comparison of demographic data between patients remaining compensated and individuals progressing to decompensation during the follow-up period
Patients remaining compensated (n = 107)
Patients progressing to decompensation (n = 43)
P value
Male [n (%)]66 (61.7)22 (51.2)NS1
Female [n (%)]41 (38.3)21 (48.8)NS1
Age (mean ± SD)61.81 ± 10.9966.47 ± 12.01NS2
Child-Pugh Grade A [n (%)]78 (72.9)29 (67.5)NS1
Child-Pugh Grade B [n (%)]29 (27.1)14 (32.5)NS1
1Chi-square test.
2Mann-Whitney U test.
Statistically significant differences (P < 0.05) are reported in bold. NS: Not statistically significant.
Table 6 Comparison of anthropometric indexes between patients remaining compensated and individuals progressing to decompensation during the follow-up period
Variables (mean ± SD)Patients remaining compensated (n = 107)Patients progressing to decompensation (n = 43)P value1
BMI (kg/m2)33.58 ± 2.2830.18 ± 3.13NS
WhR1.79 ± 0.831.01 ± 0.13NS
Systolic blood pressure (mm/Hg)130.5 ± 13.49131.2 ± 10.05NS
Diastolic blood pressure (mm/Hg)87.85 ± 8.8586.05 ± 7.83NS
1Mann-Whitney U test.
Statistically significant differences (P < 0.05) are reported in bold. BMI: Body mass index; WhR: Waist to hip ratio. NS: Not statistically significant.
Table 7 Comparison of biochemical parameters between patients remaining compensated and individuals progressing to decompensation during the follow-up period
Variables (mean ± SD)
Patients remaining compensated (n = 107)
Patients progressing to decompensation (n = 43)
P value1
AST (IU/L)29.28 ± 8.5532.50 ± 27.15NS
ALT (IU/L)50.13 ± 17.554.86 ± 31.4NS
Bilirubin (µmol/L)23.64 ± 4.7432.97 ± 7.10NS
PLT count (mm3)183 ± 48.7787.60 ± 28.15< 0.0001
RDW-CV (%)15.66 ± 3.5334.41 ± 23.05< 0.0001
RDW-SD (fL)53.05 ± 8.9164.30 ± 10.07< 0.0001
Albumin (g/L)35.02 ± 7.4132.48 ± 1.54NS
INR1.26 ± 0.361.89 ± 0.27NS
HOMA-IR2.94 ± 1.573.66 ± 1.26NS
Insulin (µu/mL)11.50 ± 3.3612.09 ± 2.98NS
FPG (mg/dL)121 ± 18.09120.9 ± 16.07NS
Total cholesterol (mg/dL)185.2 ± 39.71175.3 ± 54.09NS
HDL (mg/dL)43.23 ± 9.8240.13 ± 9.97NS
LDL (mg/dL)125.9 ± 37.9126.7 ± 44.51NS
Tryglicerides (mg/dL)145.8 ± 53.29162.4 ± 82.99NS
Creatinine (mg/dL)1.13 ± 0.912.13 ± 1.070.02
1Mann-Whitney U test.
Statistically significant differences (P < 0.05) are reported in bold. AST: Aspartate aminotransferase, ALT: Alanine aminotransferase, PLT: Platelets count; CV: Coefficient variation; RDW: Red-cell distribution width; INR: International normalized ratio; HOMA-IR: homeostasis model assessment for insulin resistance; n.s.: Not statistically significant.
Table 8 Receiving operator curve features using cut-off values > 0.472 as the red-cell distribution width to platelet ratio threshold in the prediction of 3-year first decompensation event
Value
95%CI
Relative risk13.6302.416 to 5.842
Reciprocal of relative risk0.27550.1712 to 0.4140
Sensitivity0.86920.7923 to 0.9204
Specificity0.90700.7840 to 0.9632
Positive predictive value0.95880.8987 to 0.9838
Negative predictive value0.73580.6042 to 0.8356
1Koopman asymptotic score.
Table 9 Type of first decompensation event of non-acute and acute decompensating patients
Type of first decompensation event
NAD-decompensating patients (n = 29)
AD-decompensating patients (n = 14)
(A) Slow/ grade 1 ascites formation [n (%)]14 (48.3)/
(B) Mild (grade 1/2) hepatic encephalopathy [n (%)]6 (20.7)/
(C) Jaundice in non-cholestatic cirrhosis [n (%)]9 (31)/
        A + B/A + C2/5
(D) Grade 2/3 ascites within less than 2 wk [n (%)]/5 (35.7)
(E) Severe acutea hepatic encephalopathy [n (%)]/4 (28.5)
(F) Acute gastrointestinal bleeding [n (%)]/2 (14.3)
(G) Acute bacterial infection/3 (21.5)
aIn patients with previous normal consciousness.
AD: Acute decompensation; NAD: Non-acute decompensation.
Table 10 Demographic baseline data of non-acute and acute decompensating patients
NAD-decompensating patients (n = 29)
AD-decompensating patients (n = 14)
P value
Male [n (%)]16 (55.2)6 (42.9)NS1
Female [n (%)]13 (44.8)8 (57.1)NS1
Age (mean ± SD)64.79 ± 12.3469.93 ± 10.91NS2
Child-Pugh Grade A [n (%)]9 (31.1)3 (21.4)NS1
Child-Pugh Grade B [n (%)]20 (68.9)11 (78.6)NS1
1Chi-square test.
2Mann-Whitney U test.
Statistically significant differences (P < 0.05) are reported in bold; NS: Not statistically significant; AD: Acute decompensation; NAD: Non-acute decompensation.
Table 11 Anthropometric indexes demographic baseline data of non-acute and acute decompensating patients
Variables (mean ± SD)
NAD-decompensating patients (n = 29)
AD-decompensating patients (n = 14)
P value1
BMI (kg/m2)29.57 ± 3.1731.43 ± 2.72NS
WhR0.99 ± 0.111.05 ± 0.17NS
Systolic blood pressure (mm/Hg)130.3 ± 9.81132.9 ± 10.59NS
Diastolic blood pressure (mm/Hg)86.03 ± 8.5986.07 ± 6.25NS
1Mann-Whitney U test.
BMI: Body mass index; WhR: Waist to hip ratio. NS: Not statistically significant; AD: Acute decompensation; NAD: Non-acute decompensation.
Table 12 Biochemical parameters data of non-acute and acute decompensating patients
Variables (mean ± SD)
NAD-decompensating patients (n = 29)
AD-decompensating patients (n =14)
P value1
AST (IU/L)27.93 ± 26.9944.11 ± 11.260.004
ALT (IU/L)40.10 ± 35.5254.71 ± 51.23NS
Bilirubin (µmol/L)21.75 ± 5.3226.94 ± 1.32NS
PLT count (mm3)100.2 ± 24.3761.57 ± 14.12< 0.0001
RDW-CV (%)26.16 ± 19.2651.51 ± 21.23< 0.0001
RDW-SD (fL)54.39 ± 10.2164.10 ± 10.14< 0.0001
Albumin (g/L)28.6 ± 2.2121.8 ± 2.59NS
INR1.76 ± 0.661.96 ± 0.62NS
HOMA-IR3.44 ± 1.294.12 ± 1.09NS
Total cholesterol (mg/dL)195.4 ± 56.20164.4 ± 44.17NS
Tryglicerides (mg/dL)167.4 ± 92.42152.1 ± 60.71NS
Creatinine (mg/dL)1.27 ± 1.512.61 ± 1.220.03
1Mann-Whitney U test.
Statistically significant differences (P < 0.05) are reported in bold. ALT: Alanine aminotransferase; PLT: Platelets count; CV: Coefficient variation; RDW: Red-cell distribution width; INR: International normalized ratio; HOMA-IR: homeostasis model assessment for insulin resistance; NS: Not statistically significant; AD: Acute decompensation; NAD: Non-acute decompensation.
Table 13 Non-invasive tools for liver disease severity assessment of non-acute and acute decompensating patients
Variables (mean ± SD)
NAD-decompensating patients (n = 29)
AD-decompensating patients (n = 14)
P value1
LSM (kPa)20.90 ± 2.0928.04 ± 3.44< 0.0001
APRI1.60 ± 0.301.90 ± 0.38< 0.0001
FIB-43.53 ± 1.753.86 ± 2.64NS
ALBI-1.98 ± 0.62-1.66 ± 0.350.03
Child-Pugh6.89 ± 0.977.42 ± 0.750.046
MELD11.07 ± 3.3513.79 ± 2.070.011
RDW (fL)/PLT ratio0.668 ± 0.1521.077 ± 0.253< 0.0001
1Mann-Whitney U test.
Statistically significant differences (P < 0.05) are reported in bold. LSM: Liver stiffness measurement; APRI: Aspartate aminotransferase/platelet count ratio index; MELD: Model for End-stage Liver Disease FIB-4: Fibrosis-4; NS: Not statistically significant; AD: Acute decompensation; NAD: Non-acute decompensation.
Table 14 Receiving operator curve features using cut-off values > 0.894 as the red-cell distribution width to platelet ratio threshold in the prediction of acute decompensation as first decompensation event
Value
95%CI
Sensitivity0.93100.7804-0.9877
Specificity0.85710.6006-0.9746
Positive predictive value0.93100.7804-0.9877
Negative predictive value0.85710.6006-0.9746