RESUMEN
OBJECTIVE: Variceal bleeding is one of the most common life-threatening complications of liver cirrhosis. This study aimed to develop and evaluate a predictive score, named Platelet count, Alpha fetoprotein (AFP) and Prothrombin-INR (PAP) for the prediction of large oesophageal varices and to compare PAP score with eight common liver fibrosis scores (AAR, APRI, GUCI, BRC score, Fibro-Alfa, FIB4, Lok and Fibro-Q) in patients with hepatitis C virus (HCV) induced liver cirrhosis. METHODS: A total of 277 patients with HCV-induced liver cirrhosis were evaluated by upper gastrointestinal endoscopy for presence of varices. Liver biochemical profile, complete blood count, prothrombin time and AFP were estimated. Stepwise linear discriminant analysis and area under receiver-operating characteristic curves (AUCs) were used to create a predictive score (PAP score) comprising platelet count, AFP and prothrombin-INR. RESULTS: PAP score predicts large oesophageal varices in patients with HCV-induced liver cirrhosis with AUC of 0.85. The optimum cut-off for predicting large oesophageal varices using ROC curve analysis was 0.27. At this point the PAP score had 77% sensitivity, 86% specificity, 94% negative predictive value and 84% efficiency. The diagnostic performances (AUC) of eight common liver fibrosis scores were 0.58 for the AAR score, 0.63 for APRI, 0.66 for GUCI, 0.68 for BRC, 0.72 for Fibro-Alfa, 0.70 for FIB4, 0.72 for Lok and 0.77 for Fibro-Q. CONCLUSION: PAP scores a non-invasive, inexpensive and simple score that could predict the presence of large oesophageal varices reducing the need of endoscopy. The PAP score has a superior AUC score than other scores, suggesting improved clinical value.
Asunto(s)
Várices Esofágicas y Gástricas/diagnóstico , Várices Esofágicas y Gástricas/virología , Hepacivirus/fisiología , Cirrosis Hepática/virología , Área Bajo la Curva , Biomarcadores/metabolismo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Curva ROCRESUMEN
BACKGROUND/AIMS: Cirrhosis and portal hypertension are characterised by a hyperdynamic circulation, which is independently associated with variceal size. Non-invasive techniques for measurement of systemic haemodynamics are now available. The aim of the study was to prospectively assess the accuracy of systemic haemodynamics measured non-invasively for the detection of oesophageal varices in cirrhotic patients as compared to other currently available non-invasive methods. METHODS: In a study of 29 cirrhotic patients, systemic haemodynamics were studied non-invasively using the Finometer® (mean arterial pressure (MAP), cardiac output (CO)/index, heart rate (HR), peripheral vascular resistance) and portal pressure was assessed by hepatic venous pressure gradient. Sensitivity, specificity, predictive values and area under the receiver operating characteristic (ROC) curves were assessed for predicting presence of varices and large oesophageal varices. Results were compared to child's classification, platelet/spleen ratio and ALT/AST ratios as predictors of the presence of large varices. RESULTS: Using finometry large oesophageal varices were correctly predicted in 83% of patients compared to other non-invasive techniques (range 66-76%). CONCLUSIONS: Non-invasive assessment of systemic haemodynamics using finometry could aid the identification of patients who do not immediately require variceal surveillance reducing the numbers of endoscopies and ensuring services are provided to those most likely to benefit.