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A New and Simple Algorithm for the Noninvasive Assessment of Esophageal Varices in Cirrhotic Patients Using Serum Fibrosis Markers and Transient Elastography

Domenii publicaţii > Ştiinţe medicale + Tipuri publicaţii > Articol în revistã ştiinţificã

Autori: Stefanescu H, Grigorescu M, Lupsor M, Maniu A, Crisan D, Procopet B, Feier D, Badea R.

Editorial: J Gastrointestin Liver Dis, 20 (1), p.57-64, 2011.


Background and aim:Noninvasive serum liver fibrosis markers and liver stiffness could be used as predictors of esophageal varices in cirrhotic patients because portal hypertension is related to liver fibrosis. The aim of this study was to cmpare the performance of common serum fibrosis scores and transient elastography in diagnosing esophageal varices and to propose a new algorihm for predicting large varices. Methods: 231 consecutive cirrhotic patients (58,4% males, mean age 55,9 years) were enrolled. Routine biological test were performed, so that APRI, FIB-4, Forns Index and Lok Score could be calculated. All pacients underwent transient elastography and eso-gastroscopy. The diagnostic performance of the methods was assessed using sensitivy, specificity,positive predictive value, negative predictive , accuracy, likelihood ratios and receiver operating characteristic curves. Resolts: The Lok Score was the best among all the serum scores for diagnosing the varices. For a value higher than 0,8, it had a 45,5% positive predictive value, 86,4% negative predictive value and 67,72% diagnostic accuracy for prediction of large varices. For liver stiffness higher than 30,8 KPa, the positive predictive value was 47,3% negative predictive value 81% and diagnostic accuracy 68,32%. Using both simultaneously, the presence of large varices was predicted with a diagnostic accuracy of 78,12%, obtaining an increment in NPV and LR up to 93,67% and 0,21, respectively. Conclusion: The Lok Score is a good predictor for excluding the presence of large varices in cirrhotic patients, similary with liver stiffness. The two methods can be successfully combined into a noninvasive algorithm for the assessment of esophageal varices in cirrhotic patients.

Cuvinte cheie: transient elastography, serum fibrosis scores, noninvasive, liver cirrhosis, esophageal varices