Tools to help identify patients at risk of varices and who might benefit from endoscopic screening
| Tool | Details | Other information |
| Newcastle Varices in PBC (NVP) Score283 | Algorithm including ALP, albumin and platelet count with an AUROC for identifying patients with varices of 0.86 | Online calculator can be found at www.uk-PBC.com |
| Mayo Risk Score (not routinely used in the UK)282 | Independent predictor for the presence of varices; score >4 helps in selecting patients for endoscopic surveillance who are at risk of varices | |
| Ratio of platelet count to spleen diameter (PC:SD)284 | Simple tool with a ratio above 909 having a high negative predictive value for the presence of varices | Meta-analysis of 8 studies acknowledged that evidence grading is low and this tool should be incorporated with other assessments of risk285 |
| Measurement of portal pressure using the hepatic venous pressure gradient (HVPG) | Most accurate way to risk stratify patients. Clinically significant portal hypertension present when HVPG >10 mm Hg as this is the strongest predictor of the development of varices286 and decompensated liver disease287 | HVPG is invasive and not widely used as a screening tool. It is also important to be aware that HVPG can be inaccurate in PBC due to the possibility of pre-sinusoidal portal hypertension |
| Transient elastography | LSM correlates with HVPG and identifies patients with significant portal hypertension in various chronic liver diseases288–290 |