Diagnostic Value of Non-invasive Scoring Systems in the Prediction of Esophageal Varices in Patients with Liver Cirrhosis-Single Center Experience.

Tijana Glisic,Aleksandar Toplicanin,Jelena Martinov Nestorov,Dusan D Popovic,Milica Stojkovic Lalosevic,Iva Lolic,Ivan Rankovic,Tamara Milovanovic,Marko Aleksic,Marija Stojanovic,Vladimir Milivojevic

doi:10.3390/medicina58020158

Abstract

Background and Objectives: Upper endoscopy is considered the gold standard for screening and diagnosis of esophageal varices (EV). Non-invasive methods for predicting EV have become a research hotspot in recent years. The aim of this study was to assess the role of non-invasive scores in predicting the presence of EV in patients with liver cirrhosis, and to determine the value of these scores in predicting the outcome of patients with cirrhosis presenting with acute variceal bleeding. Materials and Methods: A total of 386 patients with liver cirrhosis were included. The model for end-stage liver disease (MELD), aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AST/ALT), AST to platelet ratio index (APRI), fibrosis-4-index (FIB-4), fibrosis index (FI), King’s Score, albumin-bilirubin (ALBI) score, and platelet-albumin-bilirubin (PALBI) score were calculated. The discriminatory capacities of the examined scores in predicting the presence of esophageal varices were tested using receiver operating characteristic (ROC) curves. Results: The ROC curve analysis showed (area under the curve) AUC values of ALBI and PALBI of 0.603, and 0.606, respectively, for the prediction of EV. APRI, MELD, PALBI, King’s, FIB-4, and ALBI scores showed statistically significant correlation with EV bleeding (p < 0.05). AUC of APRI and MELD for predicting EV bleeding were 0.662 and 0.637, respectively. The AUC value of MELD in short-term mortality was 0.761. Conclusions: ALBI and PALBI scores had modest diagnostic accuracy of EVs in liver cirrhosis. APRI and MELD can be used as a reference index for the EV bleeding, and MELD score is best associated with short-term outcome in cirrhotic patients.

Highlights

Liver cirrhosis is a chronic disease characterized by hepatocyte necrosis, formation of regenerative nodules, and fibrosis of the liver tissue
Patients with cirrhosis may have either subclinical portal hypertension (PH) (HVPG is limited to 6–10 mmHg) or clinically significant PH (CSPH) (HVPG > 10 mmHg), which is further classified as severe (HVPG > 12 mmHg) and very severe PH (HVPG > 16 mmHg)
Patients with alcoholic hepatitis, HCV and cryptogenic liver cirrhosis, had a statistically significant (p < 0.05) presence of esophageal varices (EV) when compared to other etiologies (p = 0.010 vs. 0.033 vs. 0.040, respectively). (Table 4)

Summary

Introduction

Liver cirrhosis is a chronic disease characterized by hepatocyte necrosis, formation of regenerative nodules, and fibrosis of the liver tissue. HVPG is a robust surrogate marker in many clinical applications, such as diagnosis, risk stratification, identification of patients with hepatocellular carcinoma who are candidates for liver resection, monitoring the efficacy of medical treatment, and assessment of the progression of PH. This measurement is only possible in specialized centers. The invasive nature of the procedure and an occasional need for repetition, bear the risk of possible complications These limitations have contributed to the development of alternative methods of assessing PH severity. APRI, MELD, PALBI, King’s, FIB-4, and ALBI scores showed statistically significant correlation with EV bleeding (p < 0.05). APRI and MELD can be used as a reference index for the EV bleeding, and MELD score is best associated with short-term outcome in cirrhotic patients

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