Vincenza Calvaruso1, Irene Cacciola2, Anna Licata3, Salvatore Madonia4, Rosa Benigno5, Salvatore Petta1, Fabrizio Bronte1, Elisabetta Conte1, Giuseppe Malizia6, Gaetano Bertino7, Marco Distefano8, Arturo Montineri9, Antonio Digiacomo10, Giuseppe Alaimo11, Bruno Cacopardo12, Antonio Davì13, Luigi Guarneri14, Ignazio Scalisi15, Pietro Colletti16, Fabio Cartabellotta17, Vincenzo Portelli18, Tullio Prestileo19, Alfonso Averna20, Carmelo Iacobello21, Lorenzo Mondello22, Gaetano Scifo8, Maurizio Russello5, Giovanni Squadrito2, Giovanni Raimondo2, Calogero Cammà1, Antonio Craxì1, Vito Di Marco1. 1. Sezione di Gastroenterologia e Epatologia, Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S.), University of Palermo, Palermo, Italy. 2. UOC Epatologia Clinica e Biomolecolare and AOUP G Martino, Dipartimento di Medicina Interna e Sperimentale, University of Messina, Messina, Italy. 3. UOC Medicina Interna, AOUP Paolo Giaccone, Palermo, Italy. 4. UOC Medicina Interna, AO Villa Sofia-Cervello, Palermo, Italy. 5. UOS Epatologia, ARNAS Garibaldi-Nesima, Catania, Italy. 6. UOC Gastroenterologia, AO Villa Sofia-Cervello, Palermo, Italy. 7. UOC Medicina Interna, AOUP G Rodolico, Catania, Italy. 8. UOC Malattie Infettive, Ospedale Vittorio Emanuele di Siracusa, ASP Siracusa, Siracusa, Italy. 9. UOC Malattie Infettive, Presidio Ospedaliero Ferrarotto, Catania, Italy. 10. UOC Medicina Interna, Ospedale di Comiso, ASP Ragusa, Ragusa, Italy. 11. UOC Medicina Interna, Ospedale di Agrigento, ASP Agrigento, Agrigento, Italy. 12. UOC Malattie Infettive, ARNAS Garibaldi-Nesima, Catania, Italy. 13. UOC Malattie Infettive, Ospedale di Modica, ASP Ragusa, Ragusa, Italy. 14. UOC Malattie Infettive, Ospedale di Enna, ASP Enna, Enna, Italy. 15. UOC Medicina Interna, Ospedale di Mazzara Del Vallo, ASP, Trapani, Italy. 16. UOC Malattie Infettive, Azienda Ospedaliera Universitaria Paolo Giaccone, Palermo, Italy. 17. UOC Medicina Interna, Ospedale Buccheri La Ferla, Palermo, Italy. 18. UOC Malattie Infettive, Ospedale di Trapani, ASP Trapani, Trapani, Italy. 19. UOC Malattie Infettive, ARNAS Civico-Di Cristina-Benefratelli, Palermo, Italy. 20. UOC Malattie Infettive, Ospedale di Caltanissetta, ASP Caltanissetta, Italy. 21. UOC Malattie Infettive, AO Cannizzaro, Catania, Italy. 22. UOC Malattie Infettive, AO Papardo e Piemonte, Messina, Italy.
Abstract
INTRODUCTION: The Baveno VI consensus guidelines and an expanded algorithm suggest that transient elastography (TE) and platelet (PLT) count can be used to identify patients with cirrhosis who can avoid esophagogastroduodenoscopy (EGD). The primary aims of this study were to assess the ability of a simple algorithm, which uses only laboratory parameters, to predict medium/large esophageal varices (EV) in patients with hepatitis C virus (HCV) and cirrhosis from the Rete Sicilia Selezione Terapia-HCV (RESIST-HCV) cohort and to compare the performance of the algorithm with Baveno VI and Expanded Baveno VI criteria. The secondary aim was to assess the role of TE in ruling out large EV. METHODS: In total, 1,381 patients with HCV-associated cirrhosis who had EGD and TE within 1 year of starting treatment with direct-acting antivirals were evaluated. Using multivariate logistic analysis, laboratory variables were selected to determine which were independently associated with medium/large EV to create the RESIST-HCV criteria. These criteria were tested in a training cohort with patients from a single center (Palermo) and validated with patients from the 21 other centers of the RESIST-HCV program (validation cohort). RESULTS: In the entire cohort, medium/large EV were identified in 5 of 216 patients (2.3%) using the Baveno VI criteria and 13 of 497 patients (2.6%) using the Expanded Baveno VI criteria. PLT count and albumin level were independently associated with medium/large EV. The best cut-off values were a PLT count greater than 120 × 10 cells/μL and serum albumin level greater than 3.6 g/dL; negative predictive values (NPVs) were 97.2% and 94.7%, respectively. In the training cohort of 326 patients, 119 (36.5%) met the RESIST-HCV criteria and the NPV was 99.2%. Among 1,055 patients in the validation cohort, 315 (30%) met the RESIST-HCV criteria and the NPV was 98.1%. Adding TE to the RESIST-HCV criteria reduced the avoided EGDs for approximately 25% of patients and the NPV was 98.2%. DISCUSSION: The "easy-to-use" RESIST-HCV algorithm avoids EGD for high-risk EV screening for more than 30% of patients and has the same performance criteria as TE. Using these criteria simplifies the diagnosis of portal hypertension.
INTRODUCTION: The Baveno VI consensus guidelines and an expanded algorithm suggest that transient elastography (TE) and platelet (PLT) count can be used to identify patients with cirrhosis who can avoid esophagogastroduodenoscopy (EGD). The primary aims of this study were to assess the ability of a simple algorithm, which uses only laboratory parameters, to predict medium/large esophageal varices (EV) in patients with hepatitis C virus (HCV) and cirrhosis from the Rete Sicilia Selezione Terapia-HCV (RESIST-HCV) cohort and to compare the performance of the algorithm with Baveno VI and Expanded Baveno VI criteria. The secondary aim was to assess the role of TE in ruling out large EV. METHODS: In total, 1,381 patients with HCV-associated cirrhosis who had EGD and TE within 1 year of starting treatment with direct-acting antivirals were evaluated. Using multivariate logistic analysis, laboratory variables were selected to determine which were independently associated with medium/large EV to create the RESIST-HCV criteria. These criteria were tested in a training cohort with patients from a single center (Palermo) and validated with patients from the 21 other centers of the RESIST-HCV program (validation cohort). RESULTS: In the entire cohort, medium/large EV were identified in 5 of 216 patients (2.3%) using the Baveno VI criteria and 13 of 497 patients (2.6%) using the Expanded Baveno VI criteria. PLT count and albumin level were independently associated with medium/large EV. The best cut-off values were a PLT count greater than 120 × 10 cells/μL and serum albumin level greater than 3.6 g/dL; negative predictive values (NPVs) were 97.2% and 94.7%, respectively. In the training cohort of 326 patients, 119 (36.5%) met the RESIST-HCV criteria and the NPV was 99.2%. Among 1,055 patients in the validation cohort, 315 (30%) met the RESIST-HCV criteria and the NPV was 98.1%. Adding TE to the RESIST-HCV criteria reduced the avoided EGDs for approximately 25% of patients and the NPV was 98.2%. DISCUSSION: The "easy-to-use" RESIST-HCV algorithm avoids EGD for high-risk EV screening for more than 30% of patients and has the same performance criteria as TE. Using these criteria simplifies the diagnosis of portal hypertension.
Authors: Giulio Argalia; Giuseppe Tarantino; Claudio Ventura; Daniele Campioni; Corrado Tagliati; Paola Guardati; Alba Kostandini; Marco Marzioni; Gian Marco Giuseppetti; Andrea Giovagnoni Journal: Radiol Med Date: 2021-01-25 Impact factor: 3.469
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