Abstract
Background The Baveno VI criteria based on platelet count and liver stiffness, measured by transient elastography (TE), have been proposed to rule out high-risk varices (HRV) defined as medium or large-sized varices or the presence of high-risk stigmata (cherry red spots and red wale marks). However, TE is not available in all hospitals. Recently, the Rete Sicilia Selezione Terapia hepatitis C virus (RESIST-HCV) criteria recommended that cirrhotic patients with a platelet count > 120000/μL and serum albumin > 36 g/L could avoid esophagogastroduodenoscopy (EGD) screening for HRV. Aim We aimed to validate the performance of the RESIST-HCV criteria in two cohorts predominantly characterized with hepatitis B infection. Methods Patients with compensated cirrhosis who had blood tests within three months of performing EGD and TE were enrolled retrospectively from two centers. RESIST-HCV criteria were applied to identify patients who did not require EGD screening. Results This study included 188 patients from the Xingtai cohort (28 (14.9%) with HRV) and 104 patients from the Beijing cohort (19 (18.3%) with HRV). Of the patients who met the RESIST-HCV criteria (83 in the Xingtai cohort and 26 in the Beijing cohort), 0 and 1 had HRV, respectively, accounting for 44.1% (Xingtai cohort) and 25% (Beijing cohort) of endoscopies that were unnecessary. In the combined cohort, 109 (37.3%) patients met the RESIST-HCV criteria, only 1 (0.9%) HRV was missed, and the negative predictive value was 99.1%. Baveno VI and Expanded Baveno VI criteria spared 15.6% and 23.3% of EGDs, respectively, while missing 0% and 4.8% of HRV, respectively. Conclusions In our population, the combined criteria based on platelet count and serum albumin performed well, saving 30-40% of EGDs and correctly identifying 99.1% of patients who could safely avoid screening endoscopies for high-risk varices in compensated cirrhotic patients.
Highlights
Portal hypertension (PH) is a common complication of liver cirrhosis, and it promotes the transition from the preclinical to the clinical phase of liver cirrhosis
There were 109 (37.3%) patients who fulfilled the RESIST-hepatitis C virus (HCV) criteria ruling out the presence of high-risk varices (HRV) and could have avoided screening endoscopy
We validated the recently published RESIST-HCV criteria [13] that use only platelet count and serum albumin level to identify patients who are at low risk of HRV and can safely avoid endoscopic screening, saving time and reducing costs
Summary
Portal hypertension (PH) is a common complication of liver cirrhosis, and it promotes the transition from the preclinical to the clinical phase of liver cirrhosis. Esophagogastroduodenoscopy (EGD) remains the gold standard diagnostic method for GEV and should be performed to screen for the presence of GEV in all patients who are first diagnosed with liver cirrhosis, in accordance with the recent Baveno VI consensus [5]. A variable proportion of cirrhotic patients will not have GEV, as 30%-40% of all varices and 6%-20% of HRV are seen in compensated cirrhosis [3, 6]. The Rete Sicilia Selezione Terapia hepatitis C virus (RESIST-HCV) criteria recommended that cirrhotic patients with a platelet count > 120000/μL and serum albumin > 36 g/L could avoid esophagogastroduodenoscopy (EGD) screening for HRV. The combined criteria based on platelet count and serum albumin performed well, saving 30-40% of EGDs and correctly identifying 99.1% of patients who could safely avoid screening endoscopies for high-risk varices in compensated cirrhotic patients
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