Diagnostic Accuracy of Non-invasive Laboratory-Based Fibrosis Scores in Predicting the Presence of Esophageal Varices in Liver Cirrhosis

摘要

Introduction: Non-invasive assessment of esophageal varices(EVs) may reduce endoscopic burden and cost. This studyaimed to evaluate the diagnostic accuracy of non-invasivefibrosis scores (AAR, APRI, FIB-4, King and Lok scores) for theprediction of varices in liver cirrhosis.Methods: This prospective study included 100 liver cirrhosispatients who underwent screening endoscopy for EVs. AAR,APRI, FIB-4, King and Lok scores were assessed. The receiveroperating characteristic curves (ROC) were plotted tomeasure and compare the performance of each score forpredicting EVs and to obtain the corresponding optimalprediction value.Results: Of the 100 patients, 70 were males and 30 werefemales with a mean age of 54.05±11.58 years. Esophagealvarices were found in 77 patients out of which 58.44% werehigh-risk varices. Platelet count and non-invasive fibrosisscores APRI, FIB-4, Lok and King were able to discriminatepatients with and without varices. Using area under receiveroperating characteristic curve (AUROC), these scores werefound to have low to moderate diagnostic accuracy for thepresence of EVs and high-risk EVs, where the APRI score hadthe highest AUROC (0.77 and 0.70) respectively. At a cutoffvalue > 1.4, APRI score had 90.9% sensitivity, 60.9% specificityand 84 % diagnostic accuracy in predicting the presence ofvarices, while it had 84.4% sensitivity, 45.5% specificity and63% diagnostic accuracy in predicting the presence of high-risk varices, at a cutoff value > 2.02.Conclusion: APRI, AAR, FIB-4, King, and Lok scores had low tomoderate diagnostic accuracy in predicting the presence ofvarices in liver cirrhosis. The APRI score can help select apatient for the endoscopy but cannot replace endoscopy foresophageal varices screening.