The Research About VAP Scoring System And Splenic Transient Elastography Predicted Of The Degree Of Esophageal Varices And Bleeding

Objective：To investigate a VAP scoring system and spleen stiffness that could predictthe degree of esophageal varices and bleeding in patients with liver cirrhosis, and todetermine the accuracy of these parameters for evaluating the degree of esophageal varicesand bleeding.Methods: We retrospectively analyzed189patients with cirrhosis who underwentgastroscopy and CT, recorded their blood routine examination, liver function test，M-indexof spleen in CT and the result of gastroscopy as A group, and124inpatients or outpatientswith liver cirrhosis and healthy volunteers who underwent both gastroscopy and Fibroscanin the fasting state as B group, recorded their liver stiffness, spleen stiffness and the resultof gastroscopy. According to the result of gastroscopy, we divided into varicose bleedinggroup, severe varices group, moderate varices group, mild varices group, no varices groupand healthy controls group. We respectively drew the receiver operating characteristiccurves of all predicting parameters which we studied, and then calculated the area underthe receiver operating characteristic curves, and evaluated their predictive value ofesophageal varices and bleeding.Results：The area under the receiver operating characteristic curve of the VAP scoresystem, Plt/S-D, liver stiffness and spleen stiffness predicting severe and moderate varicesto bleeding group were0.901,0.838,0.955and0.989,respectively. The cut-off values wererespectively28.88,835.5,29.6KPa and45.5KPa. The area under the receiver operatingcharacteristic curve of liver stiffness for predicting varicose bleeding group was0.860(95%CI0.789~0.931). The liver stiffness cut-off value for predicting varicose bleedinggroup of33.2KPa had a specificity of66.02%, a sensitivity of95.24%. The area under thereceiver operating characteristic curve of spleen stiffness for predicting varicose bleedingwas0.923(95%CI0.875~0.971). The spleen stiffness cut-off value of55.2KPa had asensitivity of90.48%, a specificity of86.41%.Conclusions:1. Spleen stiffness can predict the degree of esophageal varices andbleeding in liver cirrhosis patients, and has a good predictive accuracy.2. The VAP scoring system has a good predictive accuracy of moderate esophageal varices, severe esophagealvarices and esophageal varices bleeding in patients with liver cirrhosis.