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Accuracy of Fibrosis-4 Index in Identification of Patients with Cirrhosis Who Could Potentially Avoid Variceal Screening Endoscopy

A potential restriction of the Baveno VI consensus, which helps to avoid unnecessary endoscopies, is the limited availability of FibroScan. We aimed to identify serum fibrosis indices that might aid in ruling out the presence of high-risk varices in cirrhotic patients. This retrospective study inclu...

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Autores principales: Ishida, Koji, Namisaki, Tadashi, Murata, Koji, Fujimoto, Yuki, Takeda, Souichi, Enomoto, Masahide, Ogawa, Hiroyuki, Takagi, Hirotetsu, Tsuji, Yuki, Kaya, Daisuke, Fujinaga, Yukihisa, Furukawa, Masanori, Sawada, Yasuhiko, Kitagawa, Kou, Sato, Shinya, Nishimura, Norihisa, Takaya, Hiroaki, Kaji, Kosuke, Shimozato, Naotaka, Kawaratani, Hideto, Moriya, Kei, Akahane, Takemi, Mitoro, Akira, Yoshiji, Hitoshi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7692323/
https://www.ncbi.nlm.nih.gov/pubmed/33138335
http://dx.doi.org/10.3390/jcm9113510
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author Ishida, Koji
Namisaki, Tadashi
Murata, Koji
Fujimoto, Yuki
Takeda, Souichi
Enomoto, Masahide
Ogawa, Hiroyuki
Takagi, Hirotetsu
Tsuji, Yuki
Kaya, Daisuke
Fujinaga, Yukihisa
Furukawa, Masanori
Sawada, Yasuhiko
Kitagawa, Kou
Sato, Shinya
Nishimura, Norihisa
Takaya, Hiroaki
Kaji, Kosuke
Shimozato, Naotaka
Kawaratani, Hideto
Moriya, Kei
Akahane, Takemi
Mitoro, Akira
Yoshiji, Hitoshi
author_facet Ishida, Koji
Namisaki, Tadashi
Murata, Koji
Fujimoto, Yuki
Takeda, Souichi
Enomoto, Masahide
Ogawa, Hiroyuki
Takagi, Hirotetsu
Tsuji, Yuki
Kaya, Daisuke
Fujinaga, Yukihisa
Furukawa, Masanori
Sawada, Yasuhiko
Kitagawa, Kou
Sato, Shinya
Nishimura, Norihisa
Takaya, Hiroaki
Kaji, Kosuke
Shimozato, Naotaka
Kawaratani, Hideto
Moriya, Kei
Akahane, Takemi
Mitoro, Akira
Yoshiji, Hitoshi
author_sort Ishida, Koji
collection PubMed
description A potential restriction of the Baveno VI consensus, which helps to avoid unnecessary endoscopies, is the limited availability of FibroScan. We aimed to identify serum fibrosis indices that might aid in ruling out the presence of high-risk varices in cirrhotic patients. This retrospective study included 541 consecutive patients with cirrhosis who underwent endoscopy and had data available for nine serum fibrosis indices, including platelet count, hyaluronic acid, 7S fragment of type 4 collagen, procollagen type III N-terminal peptide, tissue inhibitor of metalloproteinases 1, Mac-2 binding protein glycosylation isomer, fibrosis index based on four factors (FIB-4), aspartate transaminase/platelet ratio index and enhanced liver fibrosis score. Optimal index cutoffs for predicting high-risk varices were calculated in an estimation cohort (n = 127) and evaluated in a validation cohort (n = 351). The diagnostic performance of the indices was assessed by receiver operating characteristic curve analysis. In the estimation cohort, a FIB-4 cutoff of 2.78 provided the greatest diagnostic accuracy in predicting both all-grade and high-risk varices. FIB-4 had a negative predictive value of 1.00 for high-risk varices in both cohorts, and 21.3% (27/127) and 14.8% (52/351) of the estimation and validation cohorts, respectively, avoided esophagogastroduodenoscopy; no high-risk varices were missed in either cohort. FIB-4 correctly identifies the absence of high-risk varices in patients with cirrhosis. Therefore, those with a FIB-4 of ≥2.78 should undergo esophagogastroduodenoscopy, and FIB-4 determination should be recommended every 6–12 months concurrently with the other blood tests until the index value reaches 2.78 in those with a FIB-4 of <2.78.
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spelling pubmed-76923232020-11-28 Accuracy of Fibrosis-4 Index in Identification of Patients with Cirrhosis Who Could Potentially Avoid Variceal Screening Endoscopy Ishida, Koji Namisaki, Tadashi Murata, Koji Fujimoto, Yuki Takeda, Souichi Enomoto, Masahide Ogawa, Hiroyuki Takagi, Hirotetsu Tsuji, Yuki Kaya, Daisuke Fujinaga, Yukihisa Furukawa, Masanori Sawada, Yasuhiko Kitagawa, Kou Sato, Shinya Nishimura, Norihisa Takaya, Hiroaki Kaji, Kosuke Shimozato, Naotaka Kawaratani, Hideto Moriya, Kei Akahane, Takemi Mitoro, Akira Yoshiji, Hitoshi J Clin Med Article A potential restriction of the Baveno VI consensus, which helps to avoid unnecessary endoscopies, is the limited availability of FibroScan. We aimed to identify serum fibrosis indices that might aid in ruling out the presence of high-risk varices in cirrhotic patients. This retrospective study included 541 consecutive patients with cirrhosis who underwent endoscopy and had data available for nine serum fibrosis indices, including platelet count, hyaluronic acid, 7S fragment of type 4 collagen, procollagen type III N-terminal peptide, tissue inhibitor of metalloproteinases 1, Mac-2 binding protein glycosylation isomer, fibrosis index based on four factors (FIB-4), aspartate transaminase/platelet ratio index and enhanced liver fibrosis score. Optimal index cutoffs for predicting high-risk varices were calculated in an estimation cohort (n = 127) and evaluated in a validation cohort (n = 351). The diagnostic performance of the indices was assessed by receiver operating characteristic curve analysis. In the estimation cohort, a FIB-4 cutoff of 2.78 provided the greatest diagnostic accuracy in predicting both all-grade and high-risk varices. FIB-4 had a negative predictive value of 1.00 for high-risk varices in both cohorts, and 21.3% (27/127) and 14.8% (52/351) of the estimation and validation cohorts, respectively, avoided esophagogastroduodenoscopy; no high-risk varices were missed in either cohort. FIB-4 correctly identifies the absence of high-risk varices in patients with cirrhosis. Therefore, those with a FIB-4 of ≥2.78 should undergo esophagogastroduodenoscopy, and FIB-4 determination should be recommended every 6–12 months concurrently with the other blood tests until the index value reaches 2.78 in those with a FIB-4 of <2.78. MDPI 2020-10-29 /pmc/articles/PMC7692323/ /pubmed/33138335 http://dx.doi.org/10.3390/jcm9113510 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Ishida, Koji
Namisaki, Tadashi
Murata, Koji
Fujimoto, Yuki
Takeda, Souichi
Enomoto, Masahide
Ogawa, Hiroyuki
Takagi, Hirotetsu
Tsuji, Yuki
Kaya, Daisuke
Fujinaga, Yukihisa
Furukawa, Masanori
Sawada, Yasuhiko
Kitagawa, Kou
Sato, Shinya
Nishimura, Norihisa
Takaya, Hiroaki
Kaji, Kosuke
Shimozato, Naotaka
Kawaratani, Hideto
Moriya, Kei
Akahane, Takemi
Mitoro, Akira
Yoshiji, Hitoshi
Accuracy of Fibrosis-4 Index in Identification of Patients with Cirrhosis Who Could Potentially Avoid Variceal Screening Endoscopy
title Accuracy of Fibrosis-4 Index in Identification of Patients with Cirrhosis Who Could Potentially Avoid Variceal Screening Endoscopy
title_full Accuracy of Fibrosis-4 Index in Identification of Patients with Cirrhosis Who Could Potentially Avoid Variceal Screening Endoscopy
title_fullStr Accuracy of Fibrosis-4 Index in Identification of Patients with Cirrhosis Who Could Potentially Avoid Variceal Screening Endoscopy
title_full_unstemmed Accuracy of Fibrosis-4 Index in Identification of Patients with Cirrhosis Who Could Potentially Avoid Variceal Screening Endoscopy
title_short Accuracy of Fibrosis-4 Index in Identification of Patients with Cirrhosis Who Could Potentially Avoid Variceal Screening Endoscopy
title_sort accuracy of fibrosis-4 index in identification of patients with cirrhosis who could potentially avoid variceal screening endoscopy
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7692323/
https://www.ncbi.nlm.nih.gov/pubmed/33138335
http://dx.doi.org/10.3390/jcm9113510
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