Hepatology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
J Gastrointestin Liver Dis. 2011 Mar;20(1):57-64.
Noninvasive serum liver fibrosis markers and liver stiffness could be used as predictors of esophageal varices in cirrhotic patients because portal hypertension is related to liver fibrosis. The aim of this study was to compare the performance of common serum fibrosis scores and transient elastography in diagnosing esophageal varices and to propose a new algorithm for predicting large varices.
231 consecutive cirrhotic patients (58.4% males, mean age 55.9 years) were enrolled. Routine biological tests were performed, so that APRI, FIB-4, Forns Index and Lok Score could be calculated. All patients underwent transient elastography and eso-gastroscopy. The diagnostic performance of the methods was assessed using sensitivity, specificity, positive predictive value, negative predictive value, accuracy, likelihood ratios and receiver operating characteristic curves.
The Lok Score was the best among all the serum scores for diagnosing the varices. For a value higher than 0.8, it had a 45.5% positive predictive value, 86.4% negative predictive value and 67.72% diagnostic accuracy for prediction of large varices. For liver stiffness higher than 30.8KPa, the positive predictive value was 47.3%, negative predictive value 81% and diagnostic accuracy 68.32%. Using both tests simultaneously, the presence of large varices was predicted with a diagnostic accuracy of 78.12%, obtaining an increment in NPV and -LR up to 93.67% and 0.21, respectively.
The Lok Score is a good predictor for excluding the presence of large varices in cirrhotic patients, similarly with liver stiffness. The two methods can be successfully combined into a noninvasive algorithm for the assessment of esophageal varices in cirrhotic patients.
非侵入性血清肝纤维化标志物和肝脏硬度可作为肝硬化患者食管静脉曲张的预测指标，因为门静脉高压与肝纤维化有关。本研究旨在比较常用的血清纤维化评分和瞬时弹性成像在诊断食管静脉曲张中的表现，并提出一种新的预测大静脉曲张的算法。
纳入 231 例连续肝硬化患者（58.4%为男性，平均年龄 55.9 岁）。进行常规生物检测，以计算 APRI、FIB-4、Forns 指数和 Lok 评分。所有患者均行瞬时弹性成像和食管胃十二指肠镜检查。采用灵敏度、特异性、阳性预测值、阴性预测值、准确性、似然比和受试者工作特征曲线评估方法的诊断性能。
在所有血清评分中，Lok 评分是诊断静脉曲张的最佳方法。对于大于 0.8 的分值，其对大静脉曲张的预测具有 45.5%的阳性预测值、86.4%的阴性预测值和 67.72%的诊断准确性。对于肝脏硬度大于 30.8kPa，阳性预测值为 47.3%，阴性预测值为 81%，诊断准确性为 68.32%。同时使用两种检查方法，大静脉曲张的存在诊断准确率为 78.12%，可提高阴性预测值和 -LR，分别达到 93.67%和 0.21。
Lok 评分是排除肝硬化患者大静脉曲张存在的良好预测指标，与肝脏硬度相似。这两种方法可以成功地结合为一种非侵入性算法，用于评估肝硬化患者的食管静脉曲张。
