Published online Jul 14, 2017. doi: 10.3748/wjg.v23.i26.4806
Peer-review started: February 28, 2017
First decision: April 7, 2017
Revised: April 23, 2017
Accepted: June 1, 2017
Article in press: June 1, 2017
Published online: July 14, 2017
To assess “predictors” of esophageal varices (EV) and variceal bleeding using non-invasive markers in Albanian patients diagnosed with liver cirrhosis.
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.
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.
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.
Core tip: Non-invasive markers of liver fibrosis constitute a simple and practical alternative to predict the presence of esophageal varices in cirrhotic patients. However, no single or a combination of non-invasive markers has been widely evaluated for predicting the variceal bleeding, to date. Our findings from a study conducted in Albania indicate that, despite the low diagnostic accuracy, ﬁbrosis-4-index appears the most efficient non-invasive marker which can be used as an initial screening tool for cirrhotic patients in the areas with lacking endoscopy facilities. Yet, none of the non-invasive markers was a useful predictor of esophageal variceal bleeding in Albanian cirrhotic patients.