Forns index as a useful noninvasive predictor of esophageal varices in liver cirrhosis
Abstract: Rupture and bleeding
from esophageal varices are major complications of portal hypertension and
associated with a high mortality rate. Non-invasive serum markers of liver
fibrosis could be used as predictors of esophageal varices in cirrhotic
patients. The objective of this study was to assess the performance of Forns
index as a noninvasive predictor in diagnosing esophageal varices.
Methods
A cross-sectional study was done in 51 cirrhotic patients who were
admitted to Adam Malik hospital, Medan. Demographic and clinical data were
recorded and laboratory tests were performed, so that Forns index could be
calculated. The difference between Forns index and size of esophageal varices
as determined by endoscopy was tested by independent-t and Mann-Whitney analysis.
The diagnostic performance was assessed using sensitivity, specificity,
positive predictive value (PPV), negative predictive value (NPV), accuracy,
likelihood ratios and areas under the receiver operating characteristic curves
(AUROC).
Results
Of the 51 patients with esophageal varices included in this study, the
size of esophageal varices comprised F2 (37.3%), F3 (33.3), and F1 (29.4%).
Most patients were of Child-Plug C type (52.6%). There was a significant
difference between Forns index and grade of esophageal varices. The AUROC for
Forns index was 0.717 (95% CI: 0.561 - 0.872) and the cut-off >7.92 was
highly predictive to diagnose large esophageal varices with a sensitivity of
63.9%, specificity of 73.3%, PPV of 85.2%, NPV of 45.8% and accuracy of 71.7%.
Conclusion
Forns index was significantly increased in large esophageal varices.
Forns index is a good noninvasive predictor of esophageal varices in cirrhotic
patients.
Keywords: Forns index;
non-invasive parameter; esophageal varices cirrhotic patients
Author: Rizqi Arini Siregar, Leonardo
Basa Dairi, Gontar Alamsyah Siregar
Journal Code: jpkedokterangg160217
