Background and aims: Endoscopy is necessary for assessment of esophageal varices (EVs) in cirrhotic patients, but its use is limited because of the poor compliance of patients and shortage of public health resources at primary hospitals or rural areas, especially in less well developed countries. A multicenter cross-sectional study aimed to establish a novel non-invasive score for prediction of EVs in cirrhotic patients who had never undergone endoscopy.
Methods: Patients with liver cirrhosis regardless of acute upper gastrointestinal bleeding (AUGIB) who underwent the first-time upper gastrointestinal endoscopy at 11 hospitals in Liaoning Province, China were considered. Independent predictors for EVs were identified by multivariate logistic regression analysis and then combined into an equation. The diagnostic performance with area under curve (AUC) was further evaluated by receiver operating characteristic curve analysis.
Results: Overall, 363 patients were included, of whom 260 had EVs and 180 presented with AUGIB. In all patients, AUGIB, ascites, and platelets were the independent predictors for EVs. The equation (i.e., Liaoning score) was 0.466 + 1.088 × AUGIB (1 = yes; 0 = no) + 1.147 × ascites (1 = yes; 0 = no) - 0.012 × platelets, which had an AUC of 0.807 (p < 0.0001). In patients with AUGIB, ascites and platelets were the independent predictors for EVs. The equation was as follows: 1.205 + 1.557 × ascites (1 = yes; 0 = no) - 0.008 × platelets, which had an AUC of 0.782 (p < 0.0001). In patients without AUGIB, platelets was the only independent predictor for EVs, which had an AUC of 0.773 (p < 0.0001).
Conclusion: The Liaoning score is based on easy-to-access regular clinical and laboratory data and has a good diagnostic performance for non-invasive prediction of EVs in cirrhotic patients.
Trial registration: ClinicalTrials.gov Identifier: NCT02593799.
Keywords: Endoscopy; Esophageal varices; Gastrointestinal bleeding; Liver cirrhosis; Portal hypertension.