Predictive value of the Fibrosis-4 index and Serum-ascites albumin gradient for esophageal varices in cirrhotic ascites patients.

Abstract

Background: Various non-invasive markers have been studied for predicting the presence and severity of esophageal varices in patients with cirrhotic ascites. However, the performance of the FIB-4 index and SAAG in predicting esophageal varices remains unclear worldwide and is still limited in Vietnam. Methods: A prospective descriptive cross-sectional study was performed among 127 patients at Thong Nhat Hospital. Results: The FIB-4 index demonstrated predictive value for esophageal varices. The prevalence of esophageal varices is 78%. At a cut-off value of 2.375, the FIB-4 index predicted esophageal varices with the sensitivity of 79.8%, specificity of 75.0%, positive predictive value (PPV) of 91.9%, negative predictive value (NPV) of 51.3%, and an area under the curve (AUC) of 0.77. The SAAG also showed predictive value for esophageal varices. At a cut-off value of 16.35g/L, SAAG predicted esophageal varices with the sensitivity of 80.8%, specificity of 82.1%, PPV of 94.1%, NPV of 54.8%, and an AUC of 0.83. The correlation coefficient (r) between FIB-4 index and esophageal varices was 0.554 [95%CI 0.416 - 0.667, p < 0.001], between SAAG and esophageal varices was 0.687 [95%CI 0.579 - 0.771, p < 0.001]. Conclusion: The FIB-4 index and SAAG are useful, non-invasive tools for predicting esophageal varices in patients with cirrhotic ascites. The FIB-4 values of 2.375 and the SAAG values of 16.35 g/L can serve as cut-off points for the diagnosis of esophageal varices in cirrhotic ascites patients.