Can transient elastography, Fib-4, Forns Index, and Lok Score predict esophageal varices in HCV-related cirrhotic patients?
Can transient elastography, Fib-4, Forns Index, and Lok Score predict esophageal varices in HCV-related cirrhotic patients?
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DOI：
10.1016/j.gastrohep.2013.09.008
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发表时间：
2014-02-01
影响因子：
1.9
通讯作者：
El Askary, Ahmad
中科院分区：
文献类型：
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作者：
Hassan, Eman M.;Omran, Dalia A.;El Askary, Ahmad
背景：大约50%的肝硬变患者存在胃食道静脉曲张。本研究的目的是评估肝脏硬度测量(LSM)、Fib-4、Forns指数和Lok评分作为无创预测食道静脉曲张(EV)的价值。方法：这项前瞻性研究包括65例丙型肝炎病毒相关性肝硬变患者。所有患者均接受常规实验室检查、一过性弹性体格检查(TE)和食管胃十二指肠镜检查。计算FIB-4、Forns指数和Lok评分。结果：所有预测指标(LSM、FIB-4、Forns指数和LOK评分)与EV的存在和分级均有统计学意义的相关性。TE诊断EV的临界值为18.2kPa.FIB-4、Forns指数和Lok评分诊断EV的临界值分别为2.8、6.61和0.63。对于较大的静脉曲张(2、3级)，LSM的准确率最高(80%)，截断值为22.4kpa，AUROC为0.801。其敏感性为84%，特异性为72%，阳性预测值为84%，阴性预测值为72%。以FIB-4、Forns指数和Lok评分为界值分别为3.3、6.9和0.7，诊断准确率分别为70%、70%和76%。对于大型食道静脉曲张的诊断，将TE添加到其他每个诊断指标(血清纤维化评分)中提高了它们的敏感性，而它们的特异性几乎没有降低。结论：无创性预测指标可限制内窥镜筛查。这一点非常重要，因为非侵入性现在是肝病学的主要目标。(C)2013年Elsevier Espana，S.L.和AEEH y AEG。版权所有。
Background: Gastroesophageal varices are present in approximately 50% of patients with liver cirrhosis. The aim of this study was to evaluate liver stiffness measurement (LSM), Fib-4, Forns Index and Lok Score as noninvasive predictors of esophageal varices (EV).Methods: This prospective study included 65 patients with HCV-related liver cirrhosis. All patients underwent routine laboratory tests, transient elastograhy (TE) and esophagogastroduodenoscopy. FIB-4, Forns Index and Lok Score were calculated. The diagnostic performances of these methods were assessed using sensitivity, specificity, positive predictive value, negative predictive value, accuracy and receiver operating characteristic curves.Results: All predictors (LSM, FIB-4, Forns Index and Lok Score) demonstrated statistically significant correlation with the presence and the grade of EV. TE could diagnose EV at a cutoff value of 18.2 kPa. Fib-4, Forns Index, and Lok Score could diagnose EV at cutoff values of 2.8, 6.61 and 0.63, respectively. For prediction of large varices (grade 2, 3), LSM showed the highest accuracy (80%) with a cutoff of 22.4 kPa and AUROC of 0.801. Its sensitivity was 84%, specificity 72%, PPV 84% and NPV 72%. The diagnostic accuracies of FIB-4, Forns Index and Lok Score were 70%, 70% and76%, respectively, at cutoffs of 3.3, 6.9 and 0.7, respectively. For diagnosis of large esophageal varices, adding TE to each of the other diagnostic indices (serum fibrosis scores) increased their sensitivities with little decrease in their specificities. Moreover, this combination decreased the LR- in all tests.Conclusion: Noninvasive predictors can restrict endoscopic screening. This is very important as non invasiveness is now a major goal in hepatology. (C) 2013 Elsevier Espana, S.L. and AEEH y AEG. All rights reserved.