Table 4

Tools to help identify patients at risk of varices and who might benefit from endoscopic screening

ToolDetailsOther information
Newcastle Varices in PBC (NVP) Score283 Algorithm including ALP, albumin and platelet count with an AUROC for identifying patients with varices of 0.86Online 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 varicesMeta-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 elastographyLSM correlates with HVPG and identifies patients with significant portal hypertension in various chronic liver diseases288–290