Abstract
AIM
To assess "predictors" of esophageal varices (EV) and variceal bleeding using non-invasive markers in Albanian patients diagnosed with liver cirrhosis.
METHODS
One hundred thirty-nine newly diagnosed cirrhotic patients without variceal bleeding were included in this analysis. Model for end-stage liver disease (MELD), aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AST/ALT), AST to platelet ratio index (APRI), platelet count to spleen diameter (PC/SD), fibrosis-4-index (FIB-4), fibrosis index (FI) and King's Score were measured for all participants. All patients underwent endoscopic assessment within two days of hospitalization. The major end point was the first esophageal variceal bleeding (EVB) event. The diagnostic performance of "predictors" for the presence of EV and EVB were assessed by sensitivity and specificity values obtained from the receiver operating characteristics procedure.
RESULTS
FIB-4 was the only strong and significant "predictor" of esophageal varices (multivariable-adjusted OR = 1.57 for one unit increment; 95%CI: 1.15-2.14). Furthermore, a cut-off value of 3.23 for FIB-4 was a significant predictor of esophageal varices, with a sensitivity of 72%, a specificity of 58% and a proportion of area under the curve (AUC) of 66% (P = 0.01). During the follow-up (median: 31.5 mo; interquartile range: 11-59 mo), 34 patients (24%) experienced a first EVB. FIB-4 was a poor predictor of EVB (the AUC was only 51%) for a cut-off value of 5.02. Furthermore, the AUC of AST/ALT, APRI, PC/SD, FI, MELD and King's Score ranged from 45% to 55%. None of the non-invasive markers turned out to be a useful predictor of EVB.
CONCLUSION
Despite the low diagnostic accuracy, FIB-4 appears the most efficient non-invasive liver fibrosis marker which can be used as an initial screening tool for cirrhotic patients.
Original language | English |
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Pages (from-to) | 4806-4814 |
Number of pages | 9 |
Journal | World Journal of Gastroenterology |
Volume | 23 |
Issue number | 26 |
DOIs | |
Publication status | Published - 14 Jul 2017 |
Keywords
- Albania
- Esophageal varices
- Liver cirrhosis
- Non-invasive biomarkers
- Variceal bleeding
- COUNT/SPLEEN DIAMETER RATIO
- HEPATIC CIRRHOSIS
- TRANSIENT ELASTOGRAPHY
- NONINVASIVE ASSESSMENT
- PORTAL-HYPERTENSION
- DIAGNOSTIC-ACCURACY
- MARKERS
- FIB-4
- MULTICENTER
- VALIDATION