Is Transient Elastography Valuable for High Risk Esophageal Varices Prediction in Patients with Hepatitis B Related Cirrhosis?

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http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1746.2011.06889.x/abstract

Is Transient Elastography Valuable for High Risk Esophageal Varices Prediction

in Patients with Hepatitis B Related Cirrhosis?

Yong Peng Chen1,2, Qi Zhang1, Lin Dai1, Xi Er Liang2, Jie Peng1,2, Jin Lin

Hou1,2,*DOI: 10.1111/j.1440-1746.2011.06889.x

© 2011 Journal of Gastroenterology and Hepatology Foundation and Blackwell

Publishing Asia Pty Ltd

Issue

Journal of Gastroenterology and Hepatology

Accepted Article (Accepted, unedited articles published online for future

issues)

Author InformationPublication History

Author Information

1Department of Infectious Disease, Nanfang Hospital,

2Institute for Hepatology research, Southern Medical University, Guangzhou,

510515, China.

*Correspondence: Jin Lin Hou,

*Correspondence: Jin Lin Hou, M.D, Department of Infectious Diseases, Nanfang

Hospital, Southern Medical University, Guangzhou 510515, China. E-mail:

jlhousmu@...; Tel: 86-20-61641941; Fax: 86-20-61360177

This is an Accepted Article that has been peer-reviewed and approved for

publication in the Journal of Gastroenterology and Hepatology, but has yet to

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“Accepted Articleâ€; doi: 10.1111/j.1440-1746.2011.06889.x

Abstract

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.