Evaluating FIB-4 plus as a noninvasive tool for detecting esophageal varices in advanced hepatitis c fibrosis: a multicenter cohort study.

BACKGROUND: In patients with advanced liver fibrosis, one of the most common complications after the development of clinically significant portal hypertension (CSPH) is the appearance of esophageal varices (EV), which require prophylaxis with nonselective beta-blockers (NSBB) to reduce the risk of bleeding. However, there is no practical, simple tool to predict the development of esophageal varices. The aim of the study was to validate the Fibrosis-4 (FIB-4) Plus score as a predictor of EV in a cohort of patients with advanced liver fibrosis due to hepatitis C virus infection (HCV). METHODS: Retrospective cohort study in patients with advanced liver fibrosis secondary to chronic HCV infection. Endoscopy was considered the gold standard, and the risk of developing EV was estimated using the FIB-4 Plus score in this study. The concordance between both tests was evaluated using Cohen's kappa (k). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) were calculated, and a final cut-off point was proposed using the Youden index. RESULTS: The AUC for the diagnosis of EV was good (0.707±0.17; P< 0.001). A value ≥65% on the FIB-4 Plus adequately identifies patients at risk of presenting with an EV of any size, with sensitivity=70.1%, specificity=60.6%, PPV=0.64, and NPV=0.67. When evaluating only the probability of presenting a large EV, sensitivity=82.6%, specificity=50.9%, PPV=0.26, and NPV=0.93 were obtained. CONCLUSIONS: With a cut-off point of ≥65%, FIB-4 Plus is useful for predicting the diagnosis of EV in the population with advanced liver fibrosis due to HCV infection, and it could be feasible to use it as an aid in deciding the early initiation of NSBB.