Clin Endosc.  2021 Nov;54(6):857-863. 10.5946/ce.2021.028.

Evaluation of Non-invasive Fibrosis Markers in Predicting Esophageal Variceal Bleeding

• Cifci S
• Ekmen N

• KMID: 2522706
• DOI: http://doi.org/10.5946/ce.2021.028

Abstract

Background/Aims
Esophageal variceal bleeding (EVB) is an important cause of mortality and morbidity in liver cirrhosis. In this study, we aimed to predict the possibility of EVB in patients with cirrhosis using a non-invasive score.
Methods
A total of 359 patients with cirrhosis were divided into two groups based on the presence or absence of EVB. ChildTurcotte-Pugh (CTP) score, a model for end-stage liver disease, aspartate aminotransferase to alanine aminotransferase ratio, aspartate aminotransferase to platelet ratio index (APRI), fibrosis-4-index (FIB-4), aspartate aminotransferase to alanine aminotransferase ratio/platelet ratio index (AARPRI), and S-index were measured for all participants. Receiver operating characteristic curves were obtained for all parameters, and the optimal cut-off value was determined in predicting EVB.
Results
In patients with EVB, the number of platelets (PLT) were low (p<0.001) and APRI, AARPRI, FIB-4, and S-index were significantly higher than those in patients without EBV. APRI, AARPRI, FIB-4, PLT, and S-index were statistically significant predictors of EVB (p<0.05).
Conclusions
FIB-4 and AARPRI, which are non-invasive markers of fibrosis, can be used to predict EVB. In addition, the 66.5 10⁹/L cut-off value for PLT is important for EVB.

Keyword

Bleeding; Esophageal varices; Liver cirrhosis; Non-invasive biomarkers; Platelet

Figure

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  Fig. 1. Receiver operating characteristic curves for the APRI, AAR, FIB4, AARPRI, and S-index. Larger results of APRI, AAR, FIB- 4, AARPRI, and S-index indicate more diagnostic positive tests for esophageal variceal bleeding. AAR, aspartate aminotransferase to alanine aminotransferase ratio; APRI, aspartate aminotransferase-to-platelet-ratio index; AARPRI, aspartate aminotransferase to alanine aminotransferase ratio/platelet ratio index; FIB-4, fibrosis-4 index.

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  Fig. 2. Receiver operating characteristic curves for the platelet. A small number of platelets indicate a more diagnostic positive test for esophageal varices bleeding.

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