A Liver Stiffness Measurement-Based, Noninvasive Prediction Model for High-Risk Esophageal Varices in B-Viral Liver Cirrhosis

OBJECTIVES: Periodic endoscopic screening for esophageal varices (EVs) and prophylactic treatment for high-risk EVs ((HEVs); (1) medium/large EVs and (2) small EVs with red sign or decompensated cirrhosis) are currently recommended for all cirrhotic patients. However, if a simple, noninvasive test is available, many low-risk patients may safely avoid endoscopy. We developed and validated a new liver stiffness measurement (LSM)-based prediction model for HEVs. METHODS: We prospectively enrolled 280 consecutive B-viral cirrhosis patients from 2005 to 2007 (training set) and 121 from 2007 to 2008 (validation set). All underwent laboratory workups, endoscopy, LSM, and ultrasonography. For detection of HEVs, univariate and multivariate analysis were performed, using chi(2)-test/t-test and logistic regression, respectively. A prediction model was derived from multivariate predictors. RESULTS: In the training set, 90 had HEVs, and multivariate analysis showed significant differences in LSM, spleen diameter, and platelet count between patients with and without HEVs. We developed LSM-spleen diameter to platelet ratio score (LSPS): LSM x spleen diameter/platelet count. The area under the receiver-operating characteristic curve (AUROC) in the training set was 0.954. At LSPS <3.5, 94.0% negative predictive value (NPV) was provided (184 patients), whereas 94.2% positive predictive value (PPV) was achieved (69 patients) at LSPS >5.5. Overall, the likelihood of HEVs was correctly diagnosed in 253 patients (90.3%). Its predictive values were maintained at similar accuracy in subsequent validation set (AUROC = 0.953; 94.7% NPV/93.3% PPV at cutoff 3.5/5.5, respectively). CONCLUSIONS: LSPS is a reliable, noninvasive method for detection of HEVs. Patients with LSPS <3.5 may avoid endoscopy safely, whereas those with LSPS >5.5 should be considered for appropriate prophylactic treatments.