Source Department of Infectious Disease, Nanfang Hospital, Institute for Hepatology research, Southern Medical University, Guangzhou, 510515, China.
Objectives: 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 × ULN. The AUROC of TE predicting HREV was 0.73 (95% CI 0.66-0.80) overall and 0.92 (0.82-1.01) for patients with ALT ≥5×ULN. In patients with ALT ≥ 5 × ULN, cutoff 36.1kPa 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) 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. Cutoff 3.30 excluded HREV with NPV 0.946 and NLR 0.10, and cutoff 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, PSLS 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.