TITLE:
Noninvasive Fibrosis Scores as Prognostic Markers for Varices Needing Treatment in Advanced Compensated Liver Cirrhosis
AUTHORS:
Elham Ahmed Hassan, Abeer Sharaf El-Din Abd El-Rehim, Zain El-Abdeen Ahmed Sayed, Ahmed Mohmmed Ashmawy, Emad Farah Mohamed Kholef, Abeer Sabry, Wael Abd-Elgwad Elsewify
KEYWORDS:
Esophageal Varices, Hepatitis C, Liver Cirrhosis, VITRO Score
JOURNAL NAME:
Open Journal of Gastroenterology,
Vol.7 No.8,
August
30,
2017
ABSTRACT: Background/purpose: Noninvasive assessment of esophageal varices (EVs), their size and bleeding stigmata may reduce endoscopic burden, cost and drawbacks. We aimed to evaluate the diagnostic performance of noninvasive fibrosis scores (AAR, APRI, FIB-4, King and VITRO scores) in predicting the presence of EVs and high risk varices needing treatment (VNT) in HCV-related cirrhosis of Egyptian patients. Methods: This prospective study included 154 HCV-related advanced compensated cirrhotic patients with no history of bleeding who underwent screening endoscopy for EVs. AAR, APRI, FIB-4, King and VITRO scores were assessed. Results: Esophageal varices were found in 120 patients (77.9%) and VNT in 92 patients (59.7%). Apart from AAR, all scores demonstrated statistically significant correlations with the presence and the size of EVs. Using area under receiver operating characteristic curve (AUC), these scores were good predictors for the presence of EVs and VNT, where VITRO score had the highest AUC (0.920 and 0.900) and accuracy (97.1% and 87%), sensitivity (75, 82.6%), specificity (100, 93.5%), PPV (100, 95%) and NPV (53.2, 78.4%) with cutoffs >1.3 and >1.8 respectively. Conclusion: Noninvasive fibrosis scores can predict the presence of EVs and VNT. VITRO score was the best predictor with higher accuracy for clinical applicability than studied scores.