Document Detail


A new and simple algorithm for the noninvasive assessment of esophageal varices in cirrhotic patients using serum fibrosis markers and transient elastography.
MedLine Citation:
PMID:  21451799     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND AND AIM: Noninvasive serum liver fibrosis markers and liver stiffness could be used as predictors of esophageal varices in cirrhotic patients because portal hypertension is related to liver fibrosis. The aim of this study was to compare the performance of common serum fibrosis scores and transient elastography in diagnosing esophageal varices and to propose a new algorithm for predicting large varices.
METHODS: 231 consecutive cirrhotic patients (58.4% males, mean age 55.9 years) were enrolled. Routine biological tests were performed, so that APRI, FIB-4, Forns Index and Lok Score could be calculated. All patients underwent transient elastography and eso-gastroscopy. The diagnostic performance of the methods was assessed using sensitivity, specificity, positive predictive value, negative predictive value, accuracy, likelihood ratios and receiver operating characteristic curves.
RESULTS: The Lok Score was the best among all the serum scores for diagnosing the varices. For a value higher than 0.8, it had a 45.5% positive predictive value, 86.4% negative predictive value and 67.72% diagnostic accuracy for prediction of large varices. For liver stiffness higher than 30.8KPa, the positive predictive value was 47.3%, negative predictive value 81% and diagnostic accuracy 68.32%. Using both tests simultaneously, the presence of large varices was predicted with a diagnostic accuracy of 78.12%, obtaining an increment in NPV and -LR up to 93.67% and 0.21, respectively.
CONCLUSION: The Lok Score is a good predictor for excluding the presence of large varices in cirrhotic patients, similarly with liver stiffness. The two methods can be successfully combined into a noninvasive algorithm for the assessment of esophageal varices in cirrhotic patients.
Authors:
Horia Stefanescu; Mircea Grigorescu; Monica Lupsor; Anca Maniu; Dana Crisan; Bogdan Procopet; Diana Feier; Radu Badea
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of gastrointestinal and liver diseases : JGLD     Volume:  20     ISSN:  1842-1121     ISO Abbreviation:  J Gastrointestin Liver Dis     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-03-31     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101272825     Medline TA:  J Gastrointestin Liver Dis     Country:  Romania    
Other Details:
Languages:  eng     Pagination:  57-64     Citation Subset:  IM    
Affiliation:
Hepatology Department,"Iuliu Hatieganu" University of Medicine and Pharmacy; 3rd Medical Clinic, Medical Imaging Department, 19-21 Croitorilor Str., 400162, Cluj-Napoca, Romania; Email: rbadea@umfcluj.ro.
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