Clinical Value of Serum Fibrosis Biomarkers in Prediction of Esophageal Varices in Cirrhotic Patients

Abstract
Background: Esophageal varices is one of the major com-plications of portal hypertension, occur in approximately 30%-70% of cirrhotic patients. As portal hypertension is a consequence of liver fibrosis, serum fibrosis biomarkers could serve as non invasive predictors for esophageal varices and their grades.
Aim of Study: Determine the frequency and grading of esophageal varices in a group of cirrhotic patients with no history of upper gastrointestinal bleeding, and also evaluate and compare the predictive value of APRI, AAR, FIB-4, FI, and king scores in predicting the presence of varices and their grade.
Patients and Methods: One hundred and one cirrhotic patients were included in the study. The diagnosis of liver cirrhosis was based on clinical, laboratory and ultrasonographic data. An upper GIT endoscopic examination was performed for all patients for the diagnosis of presence or absence of esophageal varices. Serum fibrosis biomarkers were calculated from data available on the first day hospital admission and used as prognostic indicators for presence and grade of esophageal varices.
Results: Patients with esophageal varices had significantly lower mean values of platelet counts and albumin levels than those without esophageal varices (p=0.015, p=0.045; respec-tively). Also there was a significant difference between patients with and without esophageal varices as regard FI score (p= 0.016). Patients with medium to large esophageal varices had significantly lower mean values of platelet counts than those with no to mild esophageal varices. Also there was a significant difference between patients with medium to large esophageal varices and those with no to mild esophageal varices as regard FI, FI B-4 and King scores (p=0.003, p=0.001, p=0.017; respectively). The FI score was accurate in predicting presence of esophageal varices in cirrhotic patients. Using 3.52 cut-off value, a prediction of presence or absence of EV could be made in 62.4% of cirrhotic patients. FIB-4 (cut off value 3.64), FI (cut off value 3.65) and King (cut off value 26.65) scores may perform better in prediction of high grade esopha-geal varices than in prediction of presence of esophageal varices.
Conclusion: Fibrosis index prediction score at cut off value 3.52 is a moderately sensitive noninvasive tool that can predict the presence of esophageal varices in cirrhotic patients with acceptable accuracy. Thus can reduce the burden and make screening for esophageal varices less stressful for the patients. The combination of FI score (cut off value 3.64), FIB-4 score (cut off value 3.65) and King's score (cut off value 26.65) could be used as an initial screening tests to detect patients with high risk EV for whom endoscopy may be more beneficial. Hence the benefit of doing upper endoscopy overweight the burden of this maneuver.