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Background and aims <p>Variceal bleeding is a life-threatening complication of liver cirrhosis, necessitating reliable non-invasive predictors to minimize the use of the more invasive esophagogastroduodenoscopy (EGD). This study evaluates the diagnostic accuracy of liver stiffness measurement (LSM), Doppler ultrasound, and serum biomarkers (FIB-4, APRI, PC/SD ratio) for predicting varices and variceal bleeding.</p> Patient and methods <p>In this cross-sectional study, we enrolled 144 cirrhotic patients who were divided into 3 groups: I, no varices (<i>n = </i>37); II, non-bleeding varices (<i>n = </i>41); and III, variceal bleeding (<i>n = </i>66). All participants underwent LSM, Doppler ultrasound, and laboratory tests. The diagnostic performance of these non-invasive methods was determined using ROC curves and multivariate logistic regression.</p> Results <p>LSM (cutoff &gt; 30 kPa) showed high accuracy for predicting variceal bleeding (90% sensitivity, AUC 0.91), outperforming all Doppler parameters (AUC 0.41–0.55). PC/SD ratio (cutoff ≤ 650) also demonstrated high predictive value for variceal bleeding. LSM (cutoff &gt; 20 kPa) and PC/SD ratio (cutoff &lt; 900) showed high accuracy for predicting the presence of varices (AUC 0.90 and 0.84, respectively). Multivariate analysis identified LSM (OR 6.350, <i>p &lt;</i> 0.001), APRI score (OR 2.256, <i>p =</i> 0.047), and PC/SD ratio (OR 2.314, <i>p =</i> 0.048) as the key independent predictors for variceal bleeding. Doppler ultrasound showed low predictive value (<i>p &gt;</i> 0.05).</p> Conclusions <p>LSM, APRI, FIB-4, and PC/SD ratio are accurate non-invasive tools for prediction of varices and variceal bleeding, supporting their role in risk stratification of cirrhotic patients and reducing unnecessary EGD. Doppler ultrasound has limited value in this context.</p>

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Liver stiffness measurement, Doppler ultrasound, and serum non-invasive markers as predictors of varices and variceal bleeding in cirrhotic patients

  • 期刊论文

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  • 发表日期：

    2025年12月31日

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  • Waleed Attia Hassan,
  • Reham M. Kemaly,
  • Mostafa A. Sayed,
  • Hanan M. Nafeh

摘要

Background and aims

Variceal bleeding is a life-threatening complication of liver cirrhosis, necessitating reliable non-invasive predictors to minimize the use of the more invasive esophagogastroduodenoscopy (EGD). This study evaluates the diagnostic accuracy of liver stiffness measurement (LSM), Doppler ultrasound, and serum biomarkers (FIB-4, APRI, PC/SD ratio) for predicting varices and variceal bleeding.

Patient and methods

In this cross-sectional study, we enrolled 144 cirrhotic patients who were divided into 3 groups: I, no varices (n = 37); II, non-bleeding varices (n = 41); and III, variceal bleeding (n = 66). All participants underwent LSM, Doppler ultrasound, and laboratory tests. The diagnostic performance of these non-invasive methods was determined using ROC curves and multivariate logistic regression.

Results

LSM (cutoff > 30 kPa) showed high accuracy for predicting variceal bleeding (90% sensitivity, AUC 0.91), outperforming all Doppler parameters (AUC 0.41–0.55). PC/SD ratio (cutoff ≤ 650) also demonstrated high predictive value for variceal bleeding. LSM (cutoff > 20 kPa) and PC/SD ratio (cutoff < 900) showed high accuracy for predicting the presence of varices (AUC 0.90 and 0.84, respectively). Multivariate analysis identified LSM (OR 6.350, p < 0.001), APRI score (OR 2.256, p = 0.047), and PC/SD ratio (OR 2.314, p = 0.048) as the key independent predictors for variceal bleeding. Doppler ultrasound showed low predictive value (p > 0.05).

Conclusions

LSM, APRI, FIB-4, and PC/SD ratio are accurate non-invasive tools for prediction of varices and variceal bleeding, supporting their role in risk stratification of cirrhotic patients and reducing unnecessary EGD. Doppler ultrasound has limited value in this context.