Abstract: Objective To investigate the efficiency of different non-invasive markers in predicting esophageal variceal bleeding (EVB) in liver cirrhotic patients. Methods From January 2016 to February 2019, 86 patients with cirrhosis who underwent CT and upper gastrointestinal endoscopy examinations within six months were included. The diagnostic performances of instantaneous elastography (FibroScan), aspartate aminotransferase (AST) to alanine aminotransferase (ALT), AST to platelet ratio index (APRI), platelet count and spleen diameter (PL/SD), fibrosis index-4 (FIB-4), fibrosis index and King’s score were assessed by the receiver operating characteristic curve (ROC curve). Results Twenty one of the 86 cirrhotic patients had EVB (24.4%). Compared with non-EVB group, hemoglobin in the patients of EVB group decreased significantly (P<0.05), whereas liver stiffness measured by Fibroscan increased significantly (P<0.05). ROC analysis showed that FibroScan stiffness had the highest specificity (75.3%), PPV (51.3%), AUC (0.70) and accuracy (70.2%) in predicting EVB. Logistic regression analysis showed that there was a significant correlation between EVB and Fibroscan stiffness (OR = 1.57; 95%CI: 1.15-2.14), while other non-invasive markers (fibrosis index, King score, APRI, PL/SD and AST/ALT) did not significantly correlate with EVB. Conclusion Liver stiffness measured by FibroScan is the most reliable predictor of EVB in patients with liver cirrhosis. Despite the low diagnostic accuracy, liver stiffness is the most efficient non-invasive marker which may be used as an initial screening tool for EVB.

Key words: Esophageal varices, Liver cirrhosis, Non-invasive biomarkers, Variceal bleeding