Evaluation of the Novel PAP Score and Other Fibrosis Scores as Non-Invasive Alternative for Upper GI Endoscopy in Detection of Large Esophageal Varices in HCV-Induced Liver Cirrhosis

Document Type : Original Article


The Departments of Internal Medicine* and Clinical and Chemical Pathology**, Kasr Al-Ainy Faculty of Medicine, Cairo University


Abstract Background: Hepatic cirrhosis patientsregularly undergo screening endoscopy forvarices. The availability of non-invasive tools for the screening of esophageal varices, their size and susceptibility for bleedingcan reduce the burden of unnecessary endoscopies, the cost and drawbacks. Aim of Study: This work aimed to evaluate the diagnostic performance of a novel PAP score in detection of large-sized esophageal varices as well as other liver fibrosis scores namely Child-Pugh score, AAR, APRI, Fib-4 and Lok index. Patients and Methods: This study included 90 HCV-induced cirrhotic patients aged >_21 years with no history of HCC, NSBB therapy or upper gastrointestinal bleeding. Patients were classified into 2 groups according to endoscopic size of varices: Group 1: 60 patients with large-sized esopha-geal varices i.e grade III-IV and group 2: 30 patients with small-medium sized esophageal varices i.e grade I-II. They were subjected to medical history interview, clinical exami-nation, laboratory investigations and recent pelvi-abdominal ultrasound. Calculation of PAP, AAR, APRI, Fib-4, Child-Pugh and Lok scores and evaluation of their diagnostic per-formance in detection of large sized varices was done. Results: PAP score had poor diagnostic performance in this study with an AUC of 0.559, p-value 0.406. On the other hand, AAR, APRI, FIB-4, Lok and Child-Pugh scores were capableof discriminating patients with large-sized varices (p<0.05). FIB-4 score had the best diagnostic accuracy at cut-off value of 4.7 with AUC of 0.951 and APRI score had a high diagnostic accuracy at a cut-off value of 1.45 with AUC of 0.947. Conclusion: Non-invasive screening methods may have a value in detecting patients with large varices who need prophylactic treatment with beta-blockers. Findings of this study suggest the possible usage of FIB-4 and APRI as non-invasive tools to stratify cirrhotic patient into risk classes and possibly on the long run decrease the number of endoscopies required.