Gastroenterol Hepatol. 2014;37(2):58---65 Gastroenterología y Hepatología www.elsevier.es/gastroenterologia ORIGINAL Can transient elastography, Fib-4, Forns Index, and Lok Score predict esophageal varices in HCV-related cirrhotic patients? Eman M. Hassan a , Dalia A. Omran a,* , Mohamad L. El Beshlawey a , Mahmoud Abdo a , Ahmad El Askary b a Department of Endemic Medicine and Hepatology, Cairo University, Cairo, Egypt b Department of Internal Medicine, Ministry of Heath Hospitals, Cairo, Egypt Received 14 June 2013; accepted 20 September 2013 Available online 21 December 2013 KEYWORDS Esophageal varices; HCV; Liver stiffness measurement; Noninvasive predictors; Serum fibrosis scores Abstract Background: Gastroesophageal varices are present in approximately 50% of patients with liver cirrhosis. The aim of this study was to evaluate liver stiffness measurement (LSM), Fib-4, Forns Index and Lok Score as noninvasive predictors of esophageal varices (EV). Methods: This prospective study included 65 patients with HCV-related liver cirrhosis. All patients underwent routine laboratory tests, transient elastograhy (TE) and esophagogastro- duodenoscopy. FIB-4, Forns Index and Lok Score were calculated. The diagnostic performances of these methods were assessed using sensitivity, specificity, positive predictive value, negative predictive value, accuracy and receiver operating characteristic curves. Results: All predictors (LSM, FIB-4, Forns Index and Lok Score) demonstrated statistically sig- nificant correlation with the presence and the grade of EV. TE could diagnose EV at a cutoff value of 18.2 kPa. Fib-4, Forns Index, and Lok Score could diagnose EV at cutoff values of 2.8, 6.61 and 0.63, respectively. For prediction of large varices (grade 2, 3), LSM showed the highest accuracy (80%) with a cutoff of 22.4 kPa and AUROC of 0.801. Its sensitivity was 84%, specificity 72%, PPV 84% and NPV 72%. The diagnostic accuracies of FIB-4, Forns Index and Lok Score were 70%, 70% and76%, respectively, at cutoffs of 3.3, 6.9 and 0.7, respectively. For diagnosis of large esophageal varices, adding TE to each of the other diagnostic indices (serum fibrosis scores) increased their sensitivities with little decrease in their specificities. Moreover, this combination decreased the LR- in all tests. Conclusion: Noninvasive predictors can restrict endoscopic screening. This is very important as non invasiveness is now a major goal in hepatology. © 2013 Elsevier España, S.L. and AEEH y AEG. All rights reserved. ∗ Corresponding author. E-mail address: daliaomran2007@yahoo.com (D.A. Omran). 0210-5705/$ – see front matter © 2013 Elsevier España, S.L. and AEEH y AEG. All rights reserved. http://dx.doi.org/10.1016/j.gastrohep.2013.09.008