title: Can transient elastography, Fib-4, Forns Index, and Lok Score predict esophageal varices in HCV-related cirrhotic patients?
abstract: 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.
  
  
  CONCLUSIONS
  Noninvasive predictors can restrict endoscopic screening. This is very important as non invasiveness is now a major goal in hepatology.
authors.affiliation: Department of Endemic Medicine and Hepatology, Cairo University, Cairo, Egypt.
authors.forename: Eman M
authors.initials: EM
authors.lastname: Hassan
authors.affiliation: Department of Endemic Medicine and Hepatology, Cairo University, Cairo, Egypt. Electronic address: daliaomran2007@yahoo.com.
authors.forename: Dalia A
authors.initials: DA
authors.lastname: Omran
authors.affiliation: Department of Endemic Medicine and Hepatology, Cairo University, Cairo, Egypt.
authors.forename: Mohamad L
authors.initials: ML
authors.lastname: El Beshlawey
authors.affiliation: Department of Endemic Medicine and Hepatology, Cairo University, Cairo, Egypt.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Abdo
authors.affiliation: Department of Internal Medicine, Ministry of Heath Hospitals, Cairo, Egypt.
authors.forename: Ahmad
authors.initials: A
authors.lastname: El Askary
mesh_terms: D000367:Age Factors; D002784:Cholesterol / Q000097:blood; D003430:Cross-Sectional Studies; D004548:Elasticity; D054459:Elasticity Imaging Techniques; D016145:Endoscopy, Digestive System; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000209:etiology; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000503:physiopathology; D008099:Liver / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010976:Platelet Count; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
chemical_list: D002784:Cholesterol
keywords: Esophageal varices; HCV; Liver stiffness measurement; Medida de la rigidez hepática; Noninvasive predictors; Predictores no invasivos; Serum fibrosis scores; VHC; Valores séricos de fibrosis; Varices esofágicas