title: Liver stiffness-spleen size-to-platelet ratio risk score detects esophageal varices in chronic liver disease.
abstract: BACKGROUND
  Noninvasive markers are needed to identify esophageal varices (EV) in patients with chronic liver disease (CLD). Recently, liver stiffness (LS)-spleen size-to-platelet ratio risk score (LSPS) has been shown to predict EV in patients with chronic hepatitis C. The aim of this study was to validate the clinical value of LSPS for EV detection and identification of high risk EV in Japanese patients with CLD.
  
  
  METHODS
  A total of 230 patients with CLD who had undergone endoscopy, LS measurement, and ultrasonography between 2013 and 2015 were enrolled. The relationships between clinical data and LSPS were compared with those for other noninvasive markers (aspartate aminotransferase-to-platelet ratio, FIB-4 index, and platelet-to-spleen ratio), along with platelet count, spleen size, and LS. Diagnostic and prognostic abilities were assessed by the area under the receiver operating characteristic curve (AUC) and multivariate logistic regression.
  
  
  RESULTS
  LSPS correlated significantly with EV grade (P < 0.001) and was superior to the other noninvasive indices for determination of EV and high risk EV. Furthermore, LSPS was independently associated with the presence of EV (P < 0.001) and elevated EV risk (P = 0.013) by multivariate logistic regression analysis. The optimal cutoff values of LSPS for EV and high risk EV were 1.1 and 2.2, respectively, at which AUC, negative predictive value, and accuracy were 0.821 [95 % confidence interval (CI) 0.743-0.899], 91.9, and 84.3 % and 0.859 (95 % CI 0.736-0.981), 95.5, and 76.9 %, respectively.
  
  
  CONCLUSIONS
  LSPS represents a useful, noninvasive, accurate method to detect EV and a high EV risk in Japanese patients with CLD.
authors.affiliation: Division of Hepatology and Gastroenterology, Department of Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621 Japan.
authors.forename: Soichiro
authors.initials: S
authors.lastname: Shibata
authors.affiliation: Division of Hepatology and Gastroenterology, Department of Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621 Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Joshita
authors.affiliation: Division of Hepatology and Gastroenterology, Department of Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621 Japan.
authors.forename: Takeji
authors.identifier: 0000-0001-7985-919X
authors.initials: T
authors.lastname: Umemura
authors.affiliation: Division of Hepatology and Gastroenterology, Department of Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621 Japan.
authors.forename: Tomoo
authors.initials: T
authors.lastname: Yamazaki
authors.affiliation: Division of Hepatology and Gastroenterology, Department of Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621 Japan.
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Fujimori
authors.affiliation: Division of Hepatology and Gastroenterology, Department of Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621 Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Ichikawa
authors.affiliation: Division of Hepatology and Gastroenterology, Department of Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621 Japan.
authors.forename: Michiharu
authors.initials: M
authors.lastname: Komatsu
authors.affiliation: Division of Hepatology and Gastroenterology, Department of Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621 Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Matsumoto
authors.affiliation: Division of Hepatology and Gastroenterology, Department of Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621 Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Tanaka
keywords: CLD; Esophageal varices; LSPS; Transient elastography