Can transient elastography, Fib-4, Forns Index, and Lok Score predict esophageal varices in HCV-related cirrhotic patients?

BACKGROUND: Gastroesophageal varices are present in approximately 50% of patients with liver cirrhosis. The aim of this study was to evaluate liver stiffness measurement (LSM), Fib-4, Forns Index and Lok Score as noninvasive predictors of esophageal varices (EV). METHODS: This prospective study included 65 patients with HCV-related liver cirrhosis. All patients underwent routine laboratory tests, transient elastograhy (TE) and esophagogastroduodenoscopy. FIB-4, Forns Index and Lok Score were calculated. The diagnostic performances of these methods were assessed using sensitivity, specificity, positive predictive value, negative predictive value, accuracy and receiver operating characteristic curves. RESULTS: All predictors (LSM, FIB-4, Forns Index and Lok Score) demonstrated statistically significant correlation with the presence and the grade of EV. TE could diagnose EV at a cutoff value of 18.2kPa. Fib-4, Forns Index, and Lok Score could diagnose EV at cutoff values of 2.8, 6.61 and 0.63, respectively. For prediction of large varices (grade 2, 3), LSM showed the highest accuracy (80%) with a cutoff of 22.4kPa and AUROC of 0.801. Its sensitivity was 84%, specificity 72%, PPV 84% and NPV 72%. The diagnostic accuracies of FIB-4, Forns Index and Lok Score were 70%, 70% and76%, respectively, at cutoffs of 3.3, 6.9 and 0.7, respectively. For diagnosis of large esophageal varices, adding TE to each of the other diagnostic indices (serum fibrosis scores) increased their sensitivities with little decrease in their specificities. Moreover, this combination decreased the LR- in all tests. CONCLUSION: Noninvasive predictors can restrict endoscopic screening. This is very important as non invasiveness is now a major goal in hepatology.

Can transient elastography, Fib-4, Forns Index, and Lok Score predict esophageal varices in HCV-related cirrhotic patients?

BACKGROUND: Gastroesophageal varices are present in approximately 50% of patients with liver cirrhosis. The aim of this study was to evaluate liver stiffness measurement (LSM), Fib-4, Forns Index and Lok Score as noninvasive predictors of esophageal varices (EV).Methods This prospective study included 65 patients with HCV-related liver cirrhosis. All patients underwent routine laboratory tests, transient elastograhy (TE) and esophagogastroduodenoscopy. FIB-4, Forns Index and Lok Score were calculated. The diagnostic performances of these methods were assessed using sensitivity, specificity, positive predictive value, negative predictive value, accuracy and receiver operating characteristic curves. Results All predictors (LSM, FIB-4, Forns Index and Lok Score) demonstrated statistically significant correlation with the presence and the grade of EV. TE could diagnose EV at a cutoff value of 18.2 kPa. Fib-4, Forns Index, and Lok Score could diagnose EV at cutoff values of 2.8, 6.61 and 0.63, respectively. For prediction of large varices (grade 2, 3), LSM showed the highest accuracy (80%) with a cutoff of 22.4 kPa and AUROC of 0.801. Its sensitivity was 84%, specificity 72%, PPV 84% and NPV 72%. The diagnostic accuracies of FIB-4, Forns Index and Lok Score were 70%, 70% and76%, respectively, at cutoffs of 3.3, 6.9 and 0.7, respectively. For diagnosis of large esophageal varices, adding TE to each of the other diagnostic indices (serum fibrosis scores) increased their sensitivities with little decrease in their specificities. Moreover, this combination decreased the LR− in all tests. Conclusion Noninvasive predictors can restrict endoscopic screening. This is very important as non invasiveness is now a major goal in hepatology

ANTECEDENTES: Aproximadamente, el 50% de los pacientes con cirrosis hepática presentan varices gastroesofágicas. El objetivo de este estudio es evaluar la medida de rigidez hepática (LSM, por su nombre en inglés), FIB-4, el índice de Forns y el índice de Lok como predictoresno invasivos de varices esofágicas (VE).MÉTODOS: Este estudio prospectivo incluyó a 65 pacientes con cirrosis hepática asociada a VHC. Todos los pacientes fueron sometidos a pruebas de laboratorio rutinarias, elastografía de transición (ET) y endoscopia de las vías digestivas altas. Se calculó el FIB-4, el índice de Fornsy el índice de Lok. Se evaluó el rendimiento de estos métodos respecto al diagnóstico mediante la medición de sensibilidad, especificidad, valor predictivo positivo (VPP), valor predictivo negativo (VPN), precisión y curvas ROC. RESULTADOS: todos los predictores (LSM, FIB-4, índice de Fornse índice de Lok) mostraron una correlación estadísticamente significativa entre la presencia y el grado de EV. La elastografía de transición diagnosticó EV con un valor de corte de 18,2 KPa. El valor de corte para Fib-4, índice de Forns, índice de Lok fue de 2,8; 6,61 y 0,63 respectivamente. En la predicción de varices grandes (grado 2, 3) LSM mostró la precisión más elevada (80%) con un punto de corte de 22,4 KPa y una AUROC de 0,801. Su sensibilidad fue del 84%, la especificidad del 72%, el VPP de 84% y el VPN de 72%. La precisión diagnóstica de FIB-4, índice de Forns e índice de Lok fueron del 70, 70 y 76% respectivamente, con puntos de corte de 3,3; 6,9 y 0,7 respectivamente. Para el diagnóstico de varices esofágicas grandes, la adición de la ET a cada uno de los demás índices de diagnóstico (puntuaciones séricas de fibrosis) aumentó la sensibilidad con poca disminución de la especificidad. Además, dicha combinación disminuyó el índice de probabilidad negativo (LR-) en todas las pruebas. CONCLUSIÓN: los predictores no invasivos pueden reducir el uso de pruebas endoscópicas. Esto es muy importante puesto que el empleo de pruebas no invasivas es en la actualidad una meta importante en hepatología