title: Non-invasive ménage à trois for the prediction of high-risk varices: stepwise algorithm using lok score, liver and spleen stiffness.
abstract: OBJECTIVE
  Liver stiffness (LS), spleen stiffness (SS) and serum markers have been proposed to non-invasively assess portal hypertension or oesophageal varices (EV) in cirrhotic patients. We aimed to evaluate the performance of a stepwise algorithm that combines Lok score with LS and SS for diagnosing high-risk EV (HREV) and to compare it with other already-validated non-invasive methods.
  
  
  METHODS
  We performed a cross-sectional study including 136 consecutive compensated cirrhotic patients with various aetiologies, divided into training (90) and validation (46) set. Endoscopy was performed within 6 months from inclusion for EV screening. Spleen diameter was assessed by ultrasonography. LS and SS were measured using Fibroscan. Lok score, platelet count/spleen diameter ratio, LSM-spleen diameter to platelet ratio score and oesophageal varices risk score (EVRS) were calculated and their diagnostic accuracy for HREV was assessed. The algorithm classified patients as having/not-having HREV. Its performance was tested and compared in both groups.
  
  
  RESULTS
  In the training set, all variables could select patients with HREV with moderate accuracy, the best being LSPS (AUROC = 0.818; 0.93 sensitivity; 0.63 specificity). EVRS, however, was the only independent predictor of HREV (OR = 1.521; P = 0.032). The algorithm correctly classified 69 (76.66%) patients in the training set (P < 0.0001) and 36 (78.26%) in the validation one. In the validation group, the algorithm performed slightly better than LSPS and EVRS, showing 100% sensitivity and negative predicted value.
  
  
  CONCLUSIONS
  The stepwise algorithm combining Lok score, LS and SS could be used to select patients at low risk of having HREV and who may benefit from more distanced endoscopic evaluation.
authors.affiliation: Hepatology Unit, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
authors.forename: Horia
authors.initials: H
authors.lastname: Stefanescu
authors.forename: Corina
authors.initials: C
authors.lastname: Radu
authors.forename: Bogdan
authors.initials: B
authors.lastname: Procopet
authors.forename: Monica
authors.initials: M
authors.lastname: Lupsor-Platon
authors.forename: Alina
authors.initials: A
authors.lastname: Habic
authors.forename: Marcel
authors.initials: M
authors.lastname: Tantau
authors.forename: Mircea
authors.initials: M
authors.lastname: Grigorescu
mesh_terms: D000465:Algorithms; D003430:Cross-Sectional Studies; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis* / Q000209:etiology; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000150:complications* / Q000473:pathology; D010976:Platelet Count; D013154:Spleen / Q000000981:diagnostic imaging*; D014463:Ultrasonography
keywords: high-risk oesophagealvarices; liver stiffness; prediction algorithm; spleen stiffness