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WEPDB 202: Evaluation of risk for esophageal varices by transient elastometry in patients with HIV and HCV infection and liver cirrhosis M.K. Mausolf1, M. Berger1, J. Breitkreutz1, J. Hartikainen1, U. Joppek1, H. Schulbin1, H. Stocker1, C. Traeder1, C. Weber1, T. Weipert1, K. Arastéh1, R. Weiss2, P. Ingiliz1 Institute(s): 1Vivantes Auguste-Viktoria-Klinikum Berlin, Gastroenterology and Infectious Diseases, Berlin, Germany, 2Hematology and Infectious Diseases, Bremen, Germany Transient elastometry as a tool to predict complications of cirrhosis? Complications of cirrhosis 12 16 EV = 0 27 49 54 63 EV grade 2 or 3 EAD HCC REV Chanteloup et al. AASLD Boston 2004 -2- 75 kPa Baseline characteristics of patients with Fibroscan >12.5 kPa1 and UGI (n=68) Varices (n=17) No varices (n=51) 49 (36-70) 47 (28-66) 14 (82) 35 (68) Median BMI [kg/m2] (95%-CI) 24.5 (22-27) 23 (22-26) Median ALT level [IU/mL] (95%-CI) 69 (59-128) 66 (65-141) Median GGT level [IU/mL] (95%-CI) 72 (59-137) 110 (139-365) Median bilirubin level [mg/dL] (95%-CI) 0.95 (0.51-2.45) 0.73 (0.81-1.47) Median prothrombin time [%] (95%-CI) 73 (63-82) 89 (83-96) HCV monoinfection [No. (%)] 6 (35) 14 (27) HIV-HCV coinfection [No. (%)] 7 (41) 24 (47) Miscellanous [No. (%)] 4 (24) 13 (26) Mean liver stiffness in kPa (+/- SD) 43 (21) 28 (19) 36 (32-54) 19 (23-34) Age, median years (range) Male sex [No. (%)] P 0.01 0.005 Indication Median liver stiffness in kPa (95%-CI) 1Castera L, et al. Gastroenterology 2005;128:343–350 -3- <0.01 Significantly higher stiffness values in patients with varices 36 p<0.01 19 Esophageal varices No varices -4- Are values >36 kPa predictive for the presence of varices? Sensitivity Specificity PPV NPV 47% 75% 0.38 0.81 -5- Are values <19 kPa predictive for the absence of varices? Sensitivity Specificity PPV NPV 51% 94% 0.96 0.39 -6- Conclusions • In cirrhotic patients (stiffness >12.5 kPa) transient elastometry indicates the presence of esophageal varices by higher values („the higher, the stiffer“) • HCV infected and HIV/HCV coinfected patients with esophageal varices had median stiffness values of 36 kPa • Fibroscan cannot replace gastroscopy for the diagnosis of varices • Stiffness values <19 kPa strongly indicate the absence of esophageal varices -7- Thank you for your attention! -8- back-up slides -9- ROC curve -10-