Prediction of the varices needing treatment with non‐invasive tests in patients with compensated advanced chronic liver disease

• DOI: 10.1111/liv.14036
• Publication Date: 2018-12-27T13:53:31Z
• Authors: Han Ah Lee; Seung Up Kim; Yeon Seok Seo; Young‐Sun Lee; Seong Hee Kang; Young Kul Jung; Moon Young Kim; Ji Hoon Kim; Sang Gyune Kim; Ki Tae Suk; Soung Won Jung; Jae Young Jang; Hyonggin An; Hyung Joon Yim; Soon Ho Um
• Keywords: Adult; Liver Cirrhosis; Male; 610; Esophageal and Gastric Varices; 03 medical and health sciences; 0302 clinical medicine; Predictive Value of Tests; Hypertension, Portal; Republic of Korea; Humans; Endoscopy, Digestive System; Aged; platelet; Platelet Count; varices; Middle Aged; transient elastography; 3. Good health; Liver; ROC Curve; Elasticity Imaging Techniques; Regression Analysis; spleen; Female; prophylaxis; Spleen

AbstractBackgrounds & AimsThe Baveno VI guidelines proposed criteria including liver stiffness (LS) and platelet count to avoid screening endoscopy in patients with compensated advanced chronic liver disease (cACLD). This study was performed to validate the Baveno IV criteria and to compare its diagnostic accuracy with other non‐invasive models.MethodsPatients with cACLD who underwent laboratory tests, upper gastrointestinal endoscopy and abdominal ultrasound within 6 months of transient elastography were included.ResultsA total of 1218 patients with cACLD were included. VNT occurred in 249 patients (20.4%). With the Baveno VI criteria, the VNT miss rate was 1.9% with a 25.7% saved endoscopy rate. Using two criteria of LS <20 kPa and platelet count >110 × 109 cells/L or LS <25 kPa and platelet count >120 × 109 cells/L, the saved endoscopy rate was 39.1% while maintaining the VNT miss rate <5%. The optimal LS and platelet count‐based criteria for predicting VNT differed according to the underlying liver disease. The area under the receiver operating characteristic curve of LS‐spleen diameter to platelet score (LSPS) was 0.780 (95% confidence interval: 0.774‐0.820), which was significantly higher than other models. The optimal cut‐off value of the LSPS for predicting VNT was 1.47.ConclusionLiver stiffness and platelet count‐based criteria are useful for discriminating patients with very low risk of having VNT among patients with cACLD and are partly affected by the type of underlying liver disease. Conversely, the LSPS is a predictor of VNT in patients with cACLD regardless of the type of underlying liver disease.