Predictive Value Of FIB-4,Lok And King Scores For Esophageal Varices In Cirrhosis

Background and Objective Liver cirrhosis(LC)is a disease that seriously endangers human health all over the world,and it is also one of the major diseases that our country focuses on.Due to a variety of factors such as increased alcohol intake,changes in dietary habits,and the increase in the number of three high populations,the epidemiology and disease spectrum distribution of LC have changed compared with the past.Although the medical conditions have been greatly improved compared with the past,its morbidity and mortality are still high,resulting in a huge social and economic burden.LC is characterized by extensive fibrosis not only involving hepatic parenchyma but also the portal tract leading to the well-known complication of portal hypertension.Esophageal varice(EV)is an important complication of portal hypertension,which can threaten the life of patients.EV affects the mortality and bleeding rate of cirrhotic patients.Huge economic and health burden causes poverty of cirrhotic patients and their families every year.Therefore,the guidelines recommend that upper gastrointestinal endoscopy be performed in all patients with liver cirrhosis to screen for the presence of esophageal varices in order to assess the condition and provide direction for follow-up diagnosis and treatment plans.Since EV is present in approximately 50%of patients with cirrhosis and up to 30%of patients with cirrhosis have large varicose veins,routine endoscopic screening of patients with cirrhosis incurs significant health care service costs.Therefore,it is likely to be cost-effective to determine which patients will benefit most from routine screening.The predictive value of various noninvasive markers has been extensively studied in last two and more decades in detecting esophageal varices.These markers are emphasized to a large extend as they are simple,noninvasive,easy to obtain and economical,with some markers having good accuracy in predicting esophageal varices.Importantly,patients show more inclination toward these noninvasive methods compared to upper gastrointestinal endoscopy.Developing esophageal varices resulting from raised portal pressures in patients with liver cirrhosis has a great impact on defining the prognostic score as well as designing the management strategy in these patients.Upper gastrointestinal endoscopy for screening purposes in each patient with liver cirrhosis is not feasible in developing countries.The aim of this study was to assess the clinical value of Lok score,FIB-4 and King score in predicting EV,and to propose that they can monitor the disease progression of patients with liver cirrhosis,thereby reducing the incidence of adverse prognosis as a noninvasive,reproducible,safe,and accurate means.Materials and Methods 120 patients with cirrhosis who underwent electronic gastroscopy in the First Affiliated Hospital of Anhui Medical University from January 2017 to August 2020 were retrospectively analyzed.According to the results of electronic gastroscopy,the patients were divided into two groups:those without esophageal varices and those with esophageal varices.General data,laboratory data and imaging data were collected to calculate the Lok score,FIB-4,King score.Student t-test(if the data conforms to the normal distribution)or Mann-Whitney U-test(if the data does not conform to the normal distribution)was used to compare variables between two groups.Receiver operating characteristic curve(ROC)was drawn and the area under the curve(AUROC)was calculated to evaluate the clinical value of each index in predicting esophageal varices.Results All predictors(Lok score,FIB-4 and King score)indicated statistically significant correlation with the presence of EV.Lok score was the strong and significant "predictor" of esophageal varices with a cutoff of 0.907 and AUROC of 0.895.The sensitivity,specificity,PPV and NPV were 80.6%,95.5%,93.4%and 86.2%,respectively.FIB-4 and King score could diagnose EV at cutoff values of 2.823 and 18.134,respectively,and their diagnostic sensitivities and specificities were 48.4%and 94.4%,51.6%and 91.0%,respectively.The AUC value for FIB-4 and King score were 0.744 and 0.707 respectively.Conclusions Lok score,FIB-4 index and King score have good clinical value for predicting the presence of EV of patients with liver cirrhosis,and can be used as an alternative method for patients who cannot undergo gastroscopy,among which Lok score exhibited best.