Background & Aims
Preliminary data suggest that non-invasive methods could be useful to assess presence
of oesophageal varices (OV) in cirrhotic patients. We aimed to further investigate
simple serum non-invasive markers for diagnosing and grading OV.
Methods
A retrospective set of 510 cirrhotics and a prospective set of 110 cirrhotics were
enrolled consecutively in five centers. Platelets, AST-to-ALT ratio, AST-to-platelet-ratio
index, Forns’ index, Lok index, Fib-4, and Fibroindex were measured within 2 months from upper endoscopy, taken as a gold standard. Performance was expressed as
sensitivity, specificity, positive, and negative predictive values (PPV, NPV), accuracy,
and area under the curve (AUC).
Results
A combination of Lok index (cutoff = 1.5) and Forns’ index (cutoff = 8.8) had 0.80 AUC (0.76–0.84, 95% CI), and high NPV (>90%) to exclude clinically relevant
OV, defined as large OV or small OV with red signs or in Child–Pugh C cirrhosis. By
applying this combination, upper endoscopy would have been avoided in 1/3 of our cirrhotics.
Large OV could be excluded with 96% NPV by Lok index (cutoff = 1.5). A combination of Lok index (cutoff = 0.9) and Forns’ index (cutoff = 8.5) predicted presence of any grade OV with good performance: 0.82 AUC (0.76–0.88,
95% CI), 88% PPV.
Conclusions
Serum non-invasive markers may be useful as a first line tool to identify cirrhotic
patients in which the risk of clinically relevant OV is trivial, and to reduce the
number of upper endoscopies. However, we are still far from the possibility of replacing
upper endoscopy by simple serum non-invasive markers in the vast majority of patients.
Abbreviations:
OV (oesophageal varices), AAR (AST-to-ALT ratio), APRI (AST-to-platelet ratio index), AUC (area under the receiving operating characteristic curve), SD (standard deviation), OR (odds ratio), CI (confidence intervals), PPV (positive predictive value), NPV (negative predictive value), LR (likelihood ratio)Keywords
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Article info
Publication history
Published online: June 16, 2010
Accepted:
April 6,
2010
Received in revised form:
April 4,
2010
Received:
October 6,
2009
Identification
Copyright
© 2010 European Association for the Study of the Liver. Published by Elsevier Inc. All rights reserved.
