. 2018 Mar 28;67(9):1568–1594. doi: 10.1136/gutjnl-2017-315259

Table 4.

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 diseases^288–290