Noninvasive scores for the prediction of esophageal varices and risk stratification in patients with cirrhosis

Table 1 Test characteristics for noninvasive detection of esophageal varices

Non-invasive test	Sensitivity	Specificity	PPV	NPV	LR (+)	LR (-)	AUROC
PC/SD	89%-93%	74%-84%	73%	74%	3.5	0.12
TE	84%	62%-68%			2.3-2.58	0.24-0.26	0.82-0.84
LSPS			94% (LSPS > 5.5)	94% (LSPS < 3.5)			0.882-0.953
EV prediction score							0.909
SSM	78%-94%	76%-78%		99%	3.4	0.2	0.872-0.933
EVendo	92.3%	65.9%					0.82
Capsule endoscopy	73.7%-83%	84%- 90.5%					0.90

Other noninvasive scores exist and may be used, as shown in Table 1; EVendo score selected based on it having the highest sensitivity, negative predictive value, and endoscopies saved, though it has not yet been validated outside of the United States. EV: Esophageal varices; PPV: Positive Predictive Value; NPV: Net present value; AUROC: Area under the receiver operating characteristic; PC/SD: Platelet count to spleen diameter ratio; TE: Transient elastography; LSPS: Liver stiffness–spleen diameter to platelet ratio; SSM: Spleen stiffness measurement.

Table 2 Test characteristics for noninvasive detection of high risk esophageal varices

Non-invasive test	Sensitivity	Specificity	PPV	NPV	LR (+)	LR (-)	AUROC	HREV missed	EGDs saved
PC/SD	85%	66%			3.03	0.30	0.83	7%
TE	78%-82%	76%-77%					0.78-0.83
PLT/log10LS	100% (< 122000); 86% (< 92000)			100% (< 122k); 94% (< 92k)				0	20.6%; 6.3%
Baveno VI	87%-97%	32%-41%	6%	98%-100%	1.31	0.39	0.746-0.96	< 2%	20%-27%
Expanded Baveno VI	90%	51%		92%-96%				6.8%	51%
SSM	81%-98%	52%-66%		99.4%	2.5	0.2	0.807	2%	35.8%
EVendo	100%	49.3%		100%			0.75	2.8%	30.5%
Capsule endoscopy	72%-73.7%	90.5%-91%					0.92

Other noninvasive scores exist and may be used, as shown in Table 2; EVendo score selected based on it having the highest sensitivity, negative predictive value, and endoscopies saved, though it has not yet been validated outside of the United States. HREV: High risk esophageal varices; PPV: Positive Predictive Value; NPV: Net present value; AUROC: Area under the receiver operating characteristic; EGD: Endoscopy; PC/SD: Platelet count to spleen diameter ratio; TE: Transient elastography; PLT: Platelets; LS: Liver stiffness; SSM: Spleen stiffness measurement.