Liver Stiffness-Spleen Size-Platelet Ratio As A Useful Clinical Predictor For Esophageal Varices Bleeding In Patients With Viral Cirrhosis

The aim of this study was to determine the diagnostic accuracy of liver stiffness measurement-spleen size-to-platelet ratio score (LSPS) and clinical factors for predicting high-risk esophageal varices (HREV) in patients with viral cirrhosis. From January 2016 to November 2017, cirrhotic patients with either chronic hepatitis B or hepatitis C were consecutively included in this study. All included patients underwent liver stiffness measurement (LSM) and esophagogastroduodenoscopy examinations during the study period. LSM was performed using transient elastography with FibroScan. HREV were defined as medium-to-large esophageal varices (EV) and small EV with red color signs, while low-risk EV (LREV) as small EV without red color signs. A total of 151 patients with either HBV- or HCV-related cirrhosis were included in this study. Multivariate analysis and stepwise logistic regression analysis showed that LSPS (P < .0001; odds ratio 12.4; 95% confidence interval (CI), 5.04-30.62), platelet count/spleen size ratio (P < .0001; odds ratio 12.2; 95% CI, 5.10-29.04), and albumin level (P < .0001; odds ratio 5.5; 95% CI, 2.52-12.07) were confirmed as independent predictors of HREV. The values of area under the receiver-operating characteristic (AUROC) curves were 0.82 (95% CI, 0.75-0.89) for LSPS, 0.80 (95% CI, 0.72-0.87) for platelet count/spleen size ratio, and 0.75 (95% CI, 0.67-0.83) for albumin level. Receiver-operating characteristic curve analysis and diagnostic performance showed that LSPS was superior over other noninvasive tests in terms of AUROC. At the optimal cutoff value of 2.3 for LSPS, the values of AUROC, sensitivity, specificity, negative predictive value, positive predictive value, and accuracy were 0.82 (95% CI, 0.75-0.89), 85.4% (95% CI, 72.2%-93.9%), 68.0% (95% CI, 58.0%-76.8%), 90.9% (95% CI, 83.3%-95.3%), 55.4% (95% CI, 47.8%-62.8%), and 73.5% (95% CI, 65.7%-80.4%), respectively. However, there were no significant differences between the values of AUROC for LSPS and other noninvasive tests (P > .05, DeLong test). The results of our study showed that LSPS provided good diagnostic accuracy for detecting HREV in patients with viral cirrhosis.