Association between baseline FIB-4 score and bleeding presentation among cirrhotic patients with F3 esophageal varices without high-risk stigmata

Abstract

Aims: Esophageal variceal bleeding (EVB) remains a major cause of morbidity and mortality in patients with liver cirrhosis. Although endoscopic grading is central to risk stratification, it remains uncertain whether non-invasive fibrosis-based indices provide additional discriminatory value among patients with advanced (F3) esophageal varices without high-risk endoscopic stigmata.Methods: This retrospective single-center cohort study included 69 cirrhotic patients with F3 esophageal varices without red wale marks at index endoscopy. Baseline Child-Pugh, Model for endstage liver disease (MELD), Aminotransferase-to-Platelet Ratio Index (APRI), and fibrosis-4 (FIB-4) scores were calculated using laboratory measurements obtained within one week of the index endoscopy. The primary outcome was the mode of clinical presentation during follow-up, defined as acute variceal bleeding requiring emergency endoscopy or elective endoscopic band ligation following the development of newly detected red wale marks during scheduled surveillance. Receiver operating characteristic (ROC) analysis and logistic regression were performed to evaluate the association and discriminatory performance of baseline non-invasive markers.Results: During follow-up, 49 patients presented with acute variceal bleeding and 20 underwent elective endoscopic band ligation after developing newly detected red wale marks. Baseline FIB-4 scores were significantly higher in the bleeding presentation group than in the elective intervention group (4.9 vs. 2.9, p