Diagnostic Value of Non-invasive Scoring Systems in the Prediction of Esophageal Varices in Patients with Liver Cirrhosis—Single Center Experience

Abstract

Background and Objectives: Upper endoscopy is considered the gold standard for screening and diagnosis of esophageal varices (EV). Non-invasive methods for predicting EV have become a research hotspot in recent years. The aim of this study was to assess the role of non-invasive scores in predicting the presence of EV in patients with liver cirrhosis, and to determine the value of these scores in predicting the outcome of patients with cirrhosis presenting with acute variceal bleeding. Materials and Methods: A total of 386 patients with liver cirrhosis were included. The model for end-stage liver disease (MELD), aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AST/ALT), AST to platelet ratio index (APRI), fibrosis-4-index (FIB-4), fibrosis index (FI), King’s Score, albumin-bilirubin (ALBI) score, and platelet-albumin-bilirubin (PALBI) score were calculated. The discriminatory capacities of the examined scores in predicting the presence of esophageal varices were tested using receiver operating characteristic (ROC) curves. Results: The ROC curve analysis showed (area under the curve) AUC values of ALBI and PALBI of 0.603, and 0.606, respectively, for the prediction of EV. APRI, MELD, PALBI, King’s, FIB-4, and ALBI scores showed statistically significant correlation with EV bleeding (p < 0.05). AUC of APRI and MELD for predicting EV bleeding were 0.662 and 0.637, respectively. The AUC value of MELD in short-term mortality was 0.761. Conclusions: ALBI and PALBI scores had modest diagnostic accuracy of EVs in liver cirrhosis. APRI and MELD can be used as a reference index for the EV bleeding, and MELD score is best associated with short-term outcome in cirrhotic patients.

Intestinal fatty acid-binding protein levels in patients with cirrhosis: Implications for mucosal injury and varices

“…Notably, we found that the evaluation of small-intestinal mucosal injury using I-FABP levels had the best ability to discriminate the presence of GEV in patients with cirrhosis. Although there have been many reports on the diagnostic performance of LSM and various noninvasive scoring systems for GEV [19][20][21][22] , measuring I-FABP showed the best diagnostic performance and was superior to those in the present study. To the best of our knowledge, only one report has examined the relationship between GEV and I-FABP levels 23 .…”

Correlation of Endoscopic Findings with Meld Score in Patients with Cirrhosis

“…Our findings were also corroborated by the researchers revealing a strong correlation between MELD, ALBI, PALBI, AAR, and FIB-4 scores and the presence of EV. Specifically, the MELD score in the group of patients with EV was considerably higher than in the group of patients without EV 15 . Hsieh et al revealed that ALBI score was substantially connected with HVPG and other hemodynamic parameters, with a greater correlation coefficient compared to those of other fibrosis indicators, indicating that had a potentially crucial role 16 .…”

A Novel risk score to predict first attack of esophageal variceal bleeding in cirrhotic patients

“…which are indicators of liver dysfunction 29 . This aligns with the results of El Sheref et al, who found that lower serum albumin levels and higher bilirubin levels (> 1.45mg/dl), along with higher haemoglobin levels (> 11.5g/dl), were predictors of variceal haemorrhage 30 However Glisic et al found signi cant increase in serum bilirubin in cirrhotic non variceal patients versus patients with varices and signi cant difference as regarding serum albumin in similar patients (2.9 mg/dl in variceal patients versus 2.7 mg/dl in non-variceal patients) 31 .…”