title: A new and simple algorithm for the noninvasive assessment of esophageal varices in cirrhotic patients using serum fibrosis markers and transient elastography.
abstract: OBJECTIVE
  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 compare the performance of common serum fibrosis scores and transient elastography in diagnosing esophageal varices and to propose a new algorithm for predicting large varices.
  
  
  METHODS
  231 consecutive cirrhotic patients (58.4% males, mean age 55.9 years) were enrolled. Routine biological tests were performed, so that APRI, FIB-4, Forns Index and Lok Score could be calculated. All patients underwent transient elastography and eso-gastroscopy. The diagnostic performance of the methods was assessed using sensitivity, specificity, positive predictive value, negative predictive value, accuracy, likelihood ratios and receiver operating characteristic curves.
  
  
  RESULTS
  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 30.8KPa, the positive predictive value was 47.3%, negative predictive value 81% and diagnostic accuracy 68.32%. Using both tests 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.
  
  
  CONCLUSIONS
  The Lok Score is a good predictor for excluding the presence of large varices in cirrhotic patients, similarly with liver stiffness. The two methods can be successfully combined into a noninvasive algorithm for the assessment of esophageal varices in cirrhotic patients.
authors: Hepatology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors: Horia
authors: H
authors: Stefanescu
authors: Mircea
authors: M
authors: Grigorescu
authors: Monica
authors: M
authors: Lupsor
authors: Anca
authors: A
authors: Maniu
authors: Dana
authors: D
authors: Crisan
authors: Bogdan
authors: B
authors: Procopet
authors: Diana
authors: D
authors: Feier
authors: Radu
authors: R
authors: Badea
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D015415:Biomarkers / Q000097:blood; D054459:Elasticity Imaging Techniques / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000097:blood / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications*; D008297:Male; D008875:Middle Aged
chemical_list: D015415:Biomarkers