Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2017; 23(26): 4806-4814
Published online Jul 14, 2017. doi: 10.3748/wjg.v23.i26.4806
Predictors of esophageal varices and first variceal bleeding in liver cirrhosis patients
Bledar Kraja, Iris Mone, Ilir Akshija, Adea Koçollari, Skerdi Prifti, Genc Burazeri
Bledar Kraja, Iris Mone, Department of Biomedical Sciences, Faculty of Medicine, University of Medicine, 1001 Tirana, Albania
Bledar Kraja, Adea Koçollari, Skerdi Prifti, University Clinic of Gastrohepatology, University Hospital Center Mother Teresa, 1001 Tirana, Albania
Iris Mone, Department of Laboratory, University Hospital Center Mother Teresa, 1001 Tirana, Albania
Ilir Akshija, Department of Statistics, University Hospital Center Mother Teresa, 1001 Tirana, Albania
Genc Burazeri, Department Department of International Health, School CAPHRI, Care and Public Health Research Institute, Maastricht University, 6200 Maastricht, the Netherlands
Author contributions: Kraja B, Mone I, Prifti S and Burazeri G contributed to the study conceptualization and design, analysis and interpretation of the data and writing of the article; Akshija I and Koçollari A commented comprehensively on the manuscript; all authors have read and approved the submitted manuscript.
Conflict-of-interest statement: None of the authors have declared any conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Bledar Kraja, MD, PhD, Department of Biomedical Sciences, Faculty of Medicine, University of Medicine, Dibra Street 371, 1001 Tirana, Albania. bledarkraja@yahoo.com
Telephone: +355-67-2058760
Received: February 26, 2017
Peer-review started: February 28, 2017
First decision: April 7, 2017
Revised: April 23, 2017
Accepted: June 1, 2017
Article in press: June 1, 2017
Published online: July 14, 2017
Processing time: 136 Days and 2.8 Hours
Abstract
AIM

To assess “predictors” of esophageal varices (EV) and variceal bleeding using non-invasive markers in Albanian patients diagnosed with liver cirrhosis.

METHODS

One hundred thirty-nine newly diagnosed cirrhotic patients without variceal bleeding were included in this analysis. Model for end-stage liver disease (MELD), aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AST/ALT), AST to platelet ratio index (APRI), platelet count to spleen diameter (PC/SD), fibrosis-4-index (FIB-4), fibrosis index (FI) and King’s Score were measured for all participants. All patients underwent endoscopic assessment within two days of hospitalization. The major end point was the first esophageal variceal bleeding (EVB) event. The diagnostic performance of “predictors” for the presence of EV and EVB were assessed by sensitivity and specificity values obtained from the receiver operating characteristics procedure.

RESULTS

FIB-4 was the only strong and significant “predictor” of esophageal varices (multivariable-adjusted OR = 1.57 for one unit increment; 95%CI: 1.15-2.14). Furthermore, a cut-off value of 3.23 for FIB-4 was a significant predictor of esophageal varices, with a sensitivity of 72%, a specificity of 58% and a proportion of area under the curve (AUC) of 66% (P = 0.01). During the follow-up (median: 31.5 mo; interquartile range: 11-59 mo), 34 patients (24%) experienced a first EVB. FIB-4 was a poor predictor of EVB (the AUC was only 51%) for a cut-off value of 5.02. Furthermore, the AUC of AST/ALT, APRI, PC/SD, FI, MELD and King's Score ranged from 45% to 55%. None of the non-invasive markers turned out to be a useful predictor of EVB.

CONCLUSION

Despite the low diagnostic accuracy, FIB-4 appears the most efficient non-invasive liver fibrosis marker which can be used as an initial screening tool for cirrhotic patients.

Keywords: Albania; Esophageal varices; Liver cirrhosis; Non-invasive biomarkers; Variceal bleeding

Core tip: Non-invasive markers of liver fibrosis constitute a simple and practical alternative to predict the presence of esophageal varices in cirrhotic patients. However, no single or a combination of non-invasive markers has been widely evaluated for predicting the variceal bleeding, to date. Our findings from a study conducted in Albania indicate that, despite the low diagnostic accuracy, fibrosis-4-index appears the most efficient non-invasive marker which can be used as an initial screening tool for cirrhotic patients in the areas with lacking endoscopy facilities. Yet, none of the non-invasive markers was a useful predictor of esophageal variceal bleeding in Albanian cirrhotic patients.