Han Ah Lee1, Seung Up Kim2, Yeon Seok Seo1, Young-Sun Lee1, Seong Hee Kang3, Young Kul Jung1, Moon Young Kim3, Ji Hoon Kim1, Sang Gyune Kim4, Ki Tae Suk5, Soung Won Jung4, Jae Young Jang4, Hyonggin An6, Hyung Joon Yim1, Soon Ho Um1. 1. Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea. 2. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. 3. Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea. 4. Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea. 5. Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea. 6. Department of Biostatistics, Korea University College of Medicine, Seoul, Korea.
Abstract
BACKGROUNDS & AIMS: The 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. METHODS: Patients with cACLD who underwent laboratory tests, upper gastrointestinal endoscopy and abdominal ultrasound within 6 months of transient elastography were included. RESULTS: A 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. CONCLUSION: Liver 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.
BACKGROUNDS & AIMS: The 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. METHODS:Patients with cACLD who underwent laboratory tests, upper gastrointestinal endoscopy and abdominal ultrasound within 6 months of transient elastography were included. RESULTS: A 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. CONCLUSION:Liver 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.
Authors: Michael Colwill; Luke Lake; Ahmed El-Sayed; Jonathan King; Rawen Kader; Eathar Shakweh; Andra Caracostea; Louise China; James Maurice Journal: Future Healthc J Date: 2022-03
Authors: Zsolt Szakács; Bálint Erőss; Alexandra Soós; Péter Mátrai; Imre Szabó; Erika Pétervári; Judit Bajor; Nelli Farkas; Péter Hegyi; Anita Illés; Margit Solymár; Márta Balaskó; Patrícia Sarlós; Ákos Szűcs; József Czimmer; Áron Vincze; Gabriella Pár Journal: Front Physiol Date: 2019-08-13 Impact factor: 4.566