Clinical Value of APRI and FIB-4 on Bleeding Risk and 30-Day Prognosis in Patients with Liver Cirrhosis Complicated with Esophagogastric Varices

Qiuhui Tian,1 Yu Liu,1 Qiumei Cao,1 Mingjing Cheng,2 Meixu Zhang,1 Fengying Zhu,1 Yukai He1 1The Department of Gastroenterology and Hepatology, Jiangjin Hospital, Chongqing University of Chinese Medicine, Chongqing, People’s Republic of China; 2The Department of Laboratory Medicine, Dali Prefecture People’s Hospital, Dali City, Yunnan, People’s Republic of ChinaCorrespondence: Qiumei Cao, Department of Gastroenterology and Hepatology, Jiangjin Hospital, Chongqing University of Chinese Medicine, No. 458, Jinma Road, Degan Sub-District, Jiangjin District, Chongqing, People’s Republic of China, Email [email protected] Mingjing Cheng, Department of Clinical Laboratory Diagnostics, the Department of Laboratory Medicine, Dali Prefecture People’s Hospital, No. 35 Renmin South Road, Dali City, Yunnan Province, People’s Republic of China, Email [email protected]: 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