Is transient elastography valuable for high-risk esophageal varices prediction in patients with hepatitis-B-related cirrhosis?

• Published in: Journal of gastroenterology and hepatology Vol. 27; no. 3; pp. 533 - 539
• Main Authors: Chen, Yong Peng, Zhang, Qi, Dai, Lin, Liang, Xie Er, Peng, Jie, Hou, Jin Lin
• Format: Journal Article
• Language: English
• Published: Melbourne, Australia Blackwell Publishing Asia 01-03-2012
• Subjects: Adult; Alanine Transaminase - blood; Algorithms; Area Under Curve; Aspartate Aminotransferases - blood; Cirrhosis; Elasticity; Elasticity Imaging Techniques; Endoscopy; Esophageal and Gastric Varices - etiology; Esophageal and Gastric Varices - pathology; esophageal varices; Esophagus; Female; Hepatitis B; Hepatitis B, Chronic - complications; Humans; Liver; Liver Cirrhosis - blood; Liver Cirrhosis - complications; Liver Cirrhosis - diagnostic imaging; Liver Cirrhosis - physiopathology; liver stiffness measurement; Logistic Models; Male; Middle Aged; Platelets; predicting algorithm; Prospective Studies; Risk groups; ROC Curve; Spleen; Statistics, Nonparametric; Ultrasonics; Ultrasonography
• ISSN: 0815-9319; 1440-1746
• DOI: 10.1111/j.1440-1746.2011.06889.x

Background and Aim:  The aim of this study was to evaluate the clinical value of transient elastography (TE) for high‐risk esophageal varices (HREV) prediction in hepatitis‐B‐related cirrhosis patients.
Methods:  A total of 238 patients with hepatitis B cirrhosis were prospectively enrolled. All patients had undergone TE and upper gastrointestinal endoscopy. Diagnostic value was assessed by the area under ROC curve (AUROC), predictive value and likelihood ratio.
Results:  The size of esophageal varices correlated with liver stiffness with Kendall's tau_b 0.236 overall and 0.425 in patients with ALT ≥ 5 × upper limit of normal (ULN). The AUROC of TE predicting HREV was 0.73 (95% confidence interval 0.66–0.80) overall and 0.92 (0.82–1.01) for patients with ALT ≥ 5 × ULN. In patients with ALT ≥ 5 × ULN, cut‐off 36.1 kPa predicted HREV with a 100% negative predictive value (NPV), an indefinite negative likelihood ratio (NLR), a 72.7% positive predictive value (PPV) and a positive likelihood ratio (PLR) of 9.3. The AUROC of HREV‐predicting model, constructed by ultrasonography and TE (USLS), was 0.84 (0.77–0.90) in the training set and 0.85 (0.76–0.94) in the validating set. Cut‐off 3.30 excluded HREV with NPV 0.946 and NLR 0.10, and cut‐off 5.98 determined HREV with PPV 0.870 and PLR 10.24. Using USLS, nearly 50% of patients could avoid endoscopic screening. The model's predictive values were maintained at similar accuracy in the validation set. Differences of AUROC in USLS, liver stiffness/spleen diameter to platelet ratio score and ultrasonic score were not significant.
Conclusions:  TE may predict HREV in patients with ALT ≥ 5 × ULN. Overall, the clinical values of TE and USLS for HREV prediction should be evaluated by further studies.