Abstract
Introduction: Non-invasive assessment of esophageal varices (EVs) may reduce endoscopic burden and cost. This study aimed to evaluate the diagnostic accuracy of non-invasive fibrosis scores (AAR, APRI, FIB-4, King and Lok scores) for the prediction of varices in liver cirrhosis.
 Methods: This prospective study included 100 liver cirrhosis patients who underwent screening endoscopy for EVs. AAR, APRI, FIB-4, King and Lok scores were assessed. The receiver operating characteristic curves (ROC) were plotted to measure and compare the performance of each score for predicting EVs and to obtain the corresponding optimal prediction value.
 Results: Of the 100 patients, 70 were males and 30 were females with a mean age of 54.05±11.58 years. Esophageal varices were found in 77 patients out of which 58.44% were high-risk varices. Platelet count and non-invasive fibrosis scores APRI, FIB-4, Lok and King were able to discriminate patients with and without varices. Using area under receiver operating characteristic curve (AUROC), these scores were found to have low to moderate diagnostic accuracy for the presence of EVs and high-risk EVs, where the APRI score had the highest AUROC (0.77 and 0.70) respectively. At a cutoff value > 1.4, APRI score had 90.9% sensitivity, 60.9% specificity and 84 % diagnostic accuracy in predicting the presence of varices, while it had 84.4% sensitivity, 45.5% specificity and 63% diagnostic accuracy in predicting the presence of highrisk varices, at a cutoff value > 2.02.
 Conclusion: APRI, AAR, FIB-4, King, and Lok scores had low to moderate diagnostic accuracy in predicting the presence of varices in liver cirrhosis. The APRI score can help select a patient for the endoscopy but cannot replace endoscopy for esophageal varices screening.
Highlights
Cirrhosis is the end-stage for chronic liver disease and is the leading cause of liver-related death globally.[1]
Several non-invasive markers of varices are primarily derived from the non-invasive assessment of liver fibrosis
Several studies including meta-analysis have demonstrated that the diagnostic accuracy of Aminotransferase-platelet ratio index (APRI), Aspartate aminotransferase-Alanine aminotransferase ratio (AAR), FIB-4, Lok and King score was modest.[7, 9]
Summary
Cirrhosis is the end-stage for chronic liver disease and is the leading cause of liver-related death globally.[1]. The development of complications of portal hypertension and/or liver dysfunction is decompensated cirrhosis. It is defined by the presence of variceal hemorrhage, ascites, encephalopathy, hepatorenal syndrome, jaundice or hepatocellular carcinoma. The transition from a compensated to a decompensated stage occurs at a rate of 5 to 7% per year.[2] Esophageal variceal bleeding is a life-threatening portal hypertension-related complication in liver cirrhosis.[3] Esophageal varices are present at diagnosis in approximately 50% of cirrhotic patients and the rate of development of new varices and increase in grades of varices is 8% per year.[4] The mortality is 3.4% per year in patients with non-bleeding varices. This study aimed to evaluate the diagnostic accuracy of non-invasive fibrosis scores (AAR, APRI, FIB-4, King and Lok scores) for the prediction of varices in liver cirrhosis
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