Multicenter Retrospective Risk Assessment of Esophageal Variceal Bleeding in Patients with Cirrhosis: An Acoustic Radiation Force Impulse Elastography-Based Prediction Model.

Background/Aims: Acoustic radiation force impulse (ARFI) elastography predicts the presence of esophageal varices (EVs). We investigated whether an ARFI-based prediction model can assess EV bleeding (EVB) risk in patients with cirrhosis.

Methods: The records of 262 patients with cirrhosis who underwent ARFI elastography and endoscopic surveillance at two institutions in 2008 to 2013 were retrospectively reviewed, and ARFI-spleen diameter-to-platelet ratio scores (ASPS) were calculated.

Results: The median patient age (165 men, 97 women) was 56 years. The median ARFI velocity, spleen diameter, platelet count, and ASPS were 1.7 m/sec, 10.1 cm, 145×109 /L, and 1.16, respectively. During the median 38-month follow-up, 61 patients experienced EVB. Among all patients (179 without EVs and 83 with EVs), the cutoff value that maximized the sum of the sensitivity (73.1%) and specificity (78.4%) (area under receiver operating characteristic curve [AUROC], 0.824) for predicting EVB was 2.60. The cumulative EVB incidence was significantly higher in patients with ASPS ≥2.60 than in those with ASPS <2.60 p=" 0=" 001=" among=" patients=" with=" evs=" n="83)," 49=" had=" high-risk=" evs=" hevs=" and=" 22=" had=" evb=" the=" cumulative=" evb=" incidence=" was=" significantly=" higher=" in=" hev=" patients=" than=" in=" low-risk=" ev=" patients=" p="0.037)." at=" an=" asps=" of=" 4=" 50=" sensitivity=" 66=" 7=" specificity=" 70=" 6=" auroc=" 0=" 691=" the=" cumulative=" evb=" incidence=" was=" significantly=" higher=" in=" patients=" with=" a=" high=" asps=" than=" in=" those=" with=" a=" low=" asps=" p="0.045)." a=" higher=" asps=" independently=" predicted=" evb=" hazard=" ratio=" 4=" 072=" p="0.047).<br">.

Conclusions: ASPS can assess EVB risk in patients with cirrhosis. Prophylactic management should be considered for patients with HEVs and ASPS ≥4.50.