Abstract: Objective This study aimed to investigate the predictive performance of real-time tissue elastography with combination of aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis factor-4 (FIB-4) for esophageal varices (EV) in patients with hepatitis B-induced liver cirrhosis (LC). Methods A total of 111 patients with hepatitis B-induced LC were encountered in Chenzhou Third People's Hospital between January 2021 and December 2024, and all underwent gastroscopy for evaluation of EV. Liver fibrosis index (LF_index) was obtained by using real-time tissue elastography check-up, and APRI and FIB-4 scores were routinely calculated. The predictive efficacy of these parameters for EV occurrence was analyzed by using receiver operating characteristic (ROC) curves. Results Of the 111 patients with hepatitis B-induced LC, gastroscopy found EV in 32 cases(28.8%); PLT count in patients with EV was (96.6±13.4)×10⁹/L, much lower than [(128.4±18.3)×10⁹/L, P<0.05] in those without, while there was no significant differences respect to common liver function tests between the two groups (P>0.05); the LF_index, APRI and FIB-4 scores in patients with EV were (3.4±0.7), (1.4±0.5) and (4.3±0.6), all significantly higher or greater than [(2.2±0.4), (0.5±0.2) and (1.9±0.3), respectively, P<0.05] in those without EV; ROC analysis showed that the AUC was 0.985, with sensitivity of 92.6% and specificity of 97.1%, when the LF_index was combined with APRI and FIB-4 scores in predicting EV existence in patients with LC, much superior to any parameter did alone (P<0.05). Conclusion Real-time tissue elastography in combination with APRI and FIB-4 scores demonstrates an excellent predictive efficacy for EV in patients with hepatitis B-induced LC, which needs further clinical investigation.

Key words: Liver cirrhosis, Real-time tissue elastography, Esophageal varices, Aspartate aminotransferase-to-platelet ratio index, Fibrosis factor-4, Diagnosis