High-risk Varices In Patients Research Articles

Meta-analysis: accuracy of the Baveno VI criteria for the diagnosis of high-risk varices in patients with hepatocellular carcinoma

Meta-analysis: accuracy of the Baveno VI criteria for the diagnosis of high-risk varices in patients with hepatocellular carcinoma

Porto-mesenteric four-dimensional flow MRI: a novel non-invasive technique for assessment of gastro-oesophageal varices

ObjectivesTo assess the role of 4D flow MRI in the assessment of gastro-oesophageal varices and in the prediction of high-risk varices in patients with chronic liver disease.MethodsThirty-eight patients diagnosed with either oesophageal or gastric varices were included in this single-centre prospective study. 4D flow MRI was used to calculate peak flow, average flow and peak velocity at the portal vein confluence (PV1) and hilum (PV2), splenic vein hilum (SV1) and confluence (SV2), and superior mesenteric vein (SMV). PV and SV fractional flow changes were also measured.ResultsROC analysis revealed that both PV2 average flow and PV fractional average flow change had 100% sensitivity to predict high-risk patients with the PV fractional peak flow change having the widest area under the curve (AUC) and the highest specificity (92.3%). SV1 average flow, SV2 average flow, SV2 peak flow, and SV2 peak velocity increased significantly in patients with oesophageal compared to gastric varices included (p = 0.022, < 0.001, < 0.001 and 0.001, respectively).ConclusionBased on certain porto-mesenteric blood flow, velocity, and fractional flow change parameters, 4D flow MRI showed excellent performance in identifying high-risk patients and giving an idea about the grade and location of varices.Critical relevance statementVariceal bleeding is a major consequence of unidentified risky upper GI varices. Thus, by identifying and locating high-risk varices early, either oesophageal or gastric, using a non-invasive method like MRI, adverse events might be avoided.Key Points4D flow MRI can be used as a potential alternative for endoscopy to predict patients with high-risk varices.Based on portal vein fractional flow change, splenic flow and velocity, 4D MRI can predict and locate high-risk varices.Earlier identification of high-risk varices can allow for interventions to prevent adverse events.Graphical

Performance of spleen stiffness measurement to rule out high-risk varices in patients with porto-sinusoidal vascular disorder.

Baveno VII consensus suggests that screening endoscopy can be spared in patients with compensated cirrhosis when spleen stiffness measurement (SSM) by vibration-controlled transient elastography (VCTE) is ≤40 kPa as they have a low probability of high-risk varices (HRV). Conversely, screening endoscopy is required in all patients with porto-sinusoidal vascular disorder (PSVD). This study aimed to evaluate the performance of SSM-VCTE to rule out HRV in patients with PSVD and signs of portal hypertension. We retrospectively included patients with PSVD, ≥1 sign of portal hypertension, without history of variceal bleeding, who underwent a SSM-VCTE within 2 years before or after an upper endoscopy in 21 VALDIG centers, divided into a derivation and a validation cohort. 154 patients were included in the derivation cohort; 43% had HRV. By multivariable logistic regression analysis, SSM-VCTE >40 kPa and serum bilirubin ≥1mg/dL were associated with HRV. SSM-VCTE ≤40 kPa combined with bilirubin <1mg/dL had a sensitivity of 96% to rule out HRV, and could spare 38% of screening endoscopies, with 4% of HRV missed, and a 95% negative predictive value (NPV). In the validation cohort, including 155 patients, SSM combined with bilirubin could spare 21% of screening endoscopies, with 4% of HRV missed and a 94% NPV. This study gathering a total of 309 PSVD patients showed that SSM-VCTE ≤40 kPa combined with bilirubin <1mg/dL identifies patients with PSVD and portal hypertension with a probability of HRV <5%, in whom screening endoscopy can be spared.

Development and Validation of a Noninvasive Model for the Detection of High-Risk Varices in Patients with Unresectable HCC

Background and AimsNon-invasive variceal risk stratification systems have not been validated in patients with hepatocellular carcinoma (HCC), which presents logistical barriers for patients in the setting of systemic HCC therapy. We aimed to develop and validate a non-invasive algorithm for the prediction of varices in patients with unresectable HCC. MethodsWe performed a retrospective cohort study in 21 centers in the US including adult patients with unresectable HCC and Child Pugh A5-B7 cirrhosis diagnosed between 2007 and2019. We included patients who completed an esophagogastroduodonoscopy (EGD) within 12 months of index imaging but prior to HCC treatment. We divided the cohort into a 70:30 training set and validation set, with the goal of maximizing negative predictive value (NPV) to avoid EGD in low-risk patients. ResultsWe included 707 patients (median age 64.6 years, 80.6% male and 74.0% White). Median time from HCC diagnosis to EGD was 47 (IQR: 114) days, with 25.0% of patients having high-risk varices. A model using clinical variables alone achieved a NPV of 86.3% in the validation cohort, while a model integrating clinical and imaging variables had an NPV 97.4% in validation. The clinical and imaging model would avoid EGDs in over half of low-risk patients while misclassifying 7.7% of high-risk patients. ConclusionA model incorporating clinical and imaging data can accurately predict the absence of high-risk varices in patients with HCC and avoid EGD in many low-risk patients prior to the initiation of systemic therapy, thus expediting their care and avoiding treatment delays.

Cost-Effectiveness of the Baveno VI Criteria Compared With Endoscopy for High-Risk Varices in Patients With Child-Pugh A Cirrhosis

While upper GI endoscopy (EGD) remains the gold standard for detecting varices in cirrhosis, the Baveno VI criteria proposed a combination of transient elastography and platelet count that could rule out high-risk varices, therefore sparing the need of an endoscopy, with significant potential cost savings. We performed a cost-effectiveness analysis of the Baveno VI criteria compared to EGD in the diagnosis of high-risk varices in cirrhosis. We built an analytical decision model to estimate the cost and benefits of using the Baveno VI criteria compared to EGD in patients with Child Pugh A cirrhosis. The analysis was performed from the UK National Health Service (NHS) perspective, over one, five, and 20 years. A Markov model was populated with data from published evidence. Outcomes were measured in terms of Quality Adjusted Life Years (QALYs) and avoided deaths. The analyses were repeated for Canada and Spain, using relevant cost inputs. The Baveno VI criteria were cost-effective compared to endoscopy in all analyses. Over 1000 patients, they produced 0.16 additional QALYs at an incremental cost of £326 ($443.41) over five years, resulting in an incremental cost of £2,081 ($2,830) per additional QALY gained. The Incremental Net Monetary Benefit of Baveno VI compared to EDG was £2,808 ($3,819) over five years per patient. Baveno VI were also cost-effective in Canada and Spain. Deterministic and probabilistic sensitivity analysis supported these findings. The findings demonstrate that the Baveno VI criteria are cost-effective, suggesting that they should be considered for widespread implementation on the basis of safety, appropriateness and economic grounds.

Evaluation of spleen stiffness by 2D shear wave elastography for ruling out high risk varices in patients with chronic advanced liver disease. A systematic review and meta-analysis

ObjectivesTo systematically review the accuracy of spleen stiffness measurement (SSM) by 2D- Shear Wave Elastography (2D-SWE) in predicting high risk for bleeding varices (HRV) in cirrhotic patients. MethodsPubMed, Embase, Web of Science, Medline, Cochrane, and Google Scholar databases were searched up to 31/05/2023 for all human studies using 2D-SWE to estimate SSM and endoscopy to detect HRV. Meta-analysis was performed using a generalized linear mixed model. Publication bias was evaluated using the funnel plot asymmetry test. The Area Under the Summarized Receiver Operating Characteristic curve (AUSROC) was estimated using the “mada” package. ResultsA total of 13 studies and 1970 patients were included. Of them, 27.8 % had HRV. The pooled sensitivity and polled specificity of SSM in detecting HRV were 90 % (95 %CI:87–92 %) and 68 % (95 %CI:58–77 %), respectively, with an AUSROC at 0.86 (95 %CI:0.82–0.90). The median cutoff value of SSM in detecting HRV was 34.2 kPa. In studies including exclusively HBV cirrhotic patients, SSM's polled sensitivity and specificity in predicting HRV was 88 % (95 %CI:82–92 %) and 73 % (95 %CI:68–78 %), respectively. The AUSROC was 0.84 (95 %CI:0.81–0.87). The number of repeated measurements per patient (<5 or ≥ 5) did not affect the method’s capability. Using Aixplorer to evaluate SSM had a higher sensitivity in ruling out HRV than other 2D-SWE devices. ConclusionsOur meta-analysis supports that SSM by 2D-SWE has a good diagnostic performance for ruling out HRV in cirrhosis.

Four-dimensional flow magnetic resonance imaging for noninvasive diagnosis of clinically significant portal hypertension and high-risk gastroesophageal varices in patients with cirrhosis

IntroductionNoninvasive diagnoses of clinically significant portal hypertension (CSPH) and high-risk gastroesophageal varices are clinically relevant but challenging. Four-dimensional (4D) flow magnetic resonance imaging (MRI) provides comprehensive flow information and is a promising alternative. This study evaluated the efficacy of 4D flow MRI as a noninvasive method for diagnosing CSPH and high-risk varices in patients with liver cirrhosis. MethodsThis prospective study enrolled consecutive patients diagnosed with liver cirrhosis at a tertiary referral center between October 2020 and March 2021. Each participant underwent abdominal 4D flow MRI. Hemodynamic parameters within the portal vein, including the average and peak flow velocities, normalized flow volume (Qnormal), and regurgitant fraction (R%), were extracted and compared between healthy individuals and patients with CSPH and between participants with high- and low-risk varices. Subsequently, these parameters were incorporated into a logistic regression (LR) model refined using L1 regularization and validated using five-fold cross-validation. The diagnostic efficacy was evaluated using receiver operating characteristic (ROC) curves. ResultsEighty-two participants were enrolled (71 patients diagnosed with liver cirrhosis and 11 healthy individuals serving as controls). Among hemodynamic parameters, patients with CSPH exhibited a notable increase in Qnormal of 0.66 ​± ​0.19 ​ml∗m2/[cycle∗kg] (P ​= ​0.001) and an R% of 1.98 (2.05) (P ​= ​0.002). Similarly, patients with high-risk varices showed a higher Qnormal of 0.61 ​± ​0.15 ​ml∗m2/[cycle∗kg] (P ​< ​0.001) and R% of 1.88 (2.81) (P ​= ​0.006). ROC analysis revealed an area under the curve (AUC) for Qnormal of 0.93 and 0.91 for R% for diagnosing CSPH, while the LR model showcased a superior AUC of 0.95. For high-risk varices, Qnormal and R% showed AUC values of 0.75 and 0.70, respectively, whereas the LR model showed a higher AUC of 0.84. ConclusionAs a noninvasive imaging modality, 4D flow MRI exhibits considerable potential for the diagnosis of CSPH and high-risk gastroesophageal varices; thus, it may minimize the reliance on invasive procedures in patients with cirrhosis.

Role of P-shear wave hepatic elastography in prediction of high-risk varices in patients affected by compensated advanced chronic liver disease

Role of P-shear wave hepatic elastography in prediction of high-risk varices in patients affected by compensated advanced chronic liver disease

Prediction of High-Risk Varices in Patients with Compensated Advanced Chronic Liver Disease in Saudi Arabia.

Liver stiffness and low platelet count can predict portal hypertension and high-risk varices (HRVs) in patients with cirrhosis. Thus, screening endoscopy may not be required for all patients with compensated advanced chronic liver disease (cACLD). However, data from Saudi Arabia are limited. This study aimed to validate the Baveno VI and expanded Baveno VI criteria for screening endoscopy and identify the risk factors associated with HRVs in patients with cACLD in Saudi Arabia. We analyzed data from 215 patients with cACLD diagnosed on transient elastography (LSM > 10 kPa) and had paired platelet count and screening upper endoscopy performed within one year of diagnosis. HRVs or varices needing treatment (VNTs) were defined as medium-to-large esophageal varices (EVs), small EVs with red flags, or gastric varices. Sensitivity, specificity, and area under the receiver operating characteristic curve were calculated. Univariate and multivariate logistic regression analyses identified HRV risk factors. The Baveno VI criteria spared 50.7% of endoscopies, missing 3.7% of VNTs, while the expanded Baveno VI criteria spared 63.7% of endoscopies, missing 5.1% VNTs. An LSM <20 kPa and platelet count > 150,000/µL were associated with HRV in 8.1% and 8.3%, respectively. While an LSM <25 kPa and platelet count > 110,000/µL were associated with HRV in 9.7% and 9%, respectively. The Baveno VI criteria had sensitivity and specificity of 76% and 55%, while the expanded criteria had 67% and 69%, respectively. Baveno VI criteria performed better in hepatitis C virus patients than nonalcoholic fatty liver disease patients. Multivariate logistic regression analysis revealed platelet count and LSM as predictors of HRV. The Baveno VI criteria effectively identified HRVs in cACLD patients from Saudi Arabia, reducing unnecessary endoscopies. Although the expanded criteria avoided more endoscopies, it led to a higher rate of missed HRVs.

OS-121-YI - Performance of spleen stiffness measurement by vibration-controlled transient elastography to rule out high-risk varices in patients with porto-sinusoidal vascular disorder

OS-121-YI - Performance of spleen stiffness measurement by vibration-controlled transient elastography to rule out high-risk varices in patients with porto-sinusoidal vascular disorder

Baveno VII Criteria Is an Accurate Risk Stratification Tool to Predict High-Risk Varices Requiring Intervention and Hepatic Events in Patients with Advanced Hepatocellular Carcinoma.

The Baveno VII criteria are used in patients with liver cirrhosis to predict high-risk varices in patients with liver cirrhosis. Yet its use in patients with advanced hepatocellular carcinoma (HCC) has not been validated. HCC alone is accompanied with a higher variceal bleeding risk due to its association with liver cirrhosis and portal vein thrombosis. The use of systemic therapy in advanced HCC has been thought to further augment this risk. Upper endoscopy is commonly used to evaluate for the presence of varices before initiation of treatment with systemic therapy. Yet it is associated with procedural risks, waiting time and limited availability in some localities which may delay the commencement of systemic therapy. Our study successfully validated the Baveno VI criteria with a 3.5% varices needing treatment (VNT) missed rate, also with acceptable <5% VNT missed rates when considering alternative liver stiffness (LSM) and platelet cut-offs. The Baveno VII clinically significant portal hypertension rule-out criteria (LSM < 15 kPa and platelet >150 × 109/L) also revealed a low frequency (2%) of hepatic events, whilst the rule-in criteria (LSM > 25 kPa) was predictive of a higher proportion of hepatic events (14%). Therefore, our study has successfully validated the Baveno VII criteria as a non-invasive stratification of the risk of variceal bleeding and hepatic decompensation in the HCC population.

Validation of Spleen Shear Wave Elastography for the Screening of High-risk Varices in Patients with Compensated Advanced Chronic Liver Disease

Validation of Spleen Shear Wave Elastography for the Screening of High-risk Varices in Patients with Compensated Advanced Chronic Liver Disease

Validation of Spleen Shear Wave Elastography for the Screening of High-risk Varices in Patients with Compensated Advanced Chronic Liver Disease.

Total number of avoided endoscopies using Baveno VI criteria is relatively low. Spleen elastography is an attractive tool and when compared with liver stiffness, it better represents the dynamic changes occurring in portal hypertension. The aim of the study was to evaluate spleen shear wave elastography (SWE) in compensated advanced chronic liver disease (cACLD) patients for ruling out the presence of esophageal high-risk varices (HRV). A total of 401 patients with cACLD were included in this cross-sectional study. The total sample was split into training set (200 patients) and validation set (201 patients). Spleen stiffness was measured with two-dimensional shear wave elastography (2D SWE). Esophageal HRV were defined as large varices (diameter &gt;5 mm) or small varices with red color signs. In the training set, the receiver operating characteristic (ROC) curve was drawn and the area under the curve (AUC) of spleen SWE was assessed. A cutoff value was chosen (highest sensitivity and negative predictive value). In the validation set, the spleen SWE cutoff score and Baveno VI criteria were validated. The prevalence of HRV was 12% in the training set and 13% in the validation set. Spleen SWE had an AUC of 0.89 in ruling out the presence of high-risk esophageal varices (cutoff value of 48.7 kPa, sensitivity of 100%, and specificity of 53%). Validating spleen SWE ≤48.7 kPa in a different cohort of 201 cACLD patients, 55% of screening endoscopies could be avoided without missing any HRV, whereas using Baveno VI criteria only 30% of screening endoscopies could be spared. Spleen SWE ≤48.7 kPa was able to identify cACLD patients who could safely avoid screening endoscopy with good accuracy. Spleen SWE could avoid an additional 25% of screening endoscopies compared to the Baveno VI criteria and no HRV were missed.

VariScreen secures the screening of high-risk varices in patients with hepatitis B virus-related cirrhosis beyond Baveno VI criteria.

We aimed to validate the performance of the ratio of the platelet count (PLT) to liver stiffness measurement (LSM) in excluding high-risk varices (HRVs) in patients with hepatitis B virus (HBV)-related compensated cirrhosis beyond Baveno VI criteria. A total of 310 patients were assessed. The performances of the PLT:LSM ratio (PLER), PLER adjusted for the international normalized ratio, etiology, age, and sex (PLEASE), and the sequential algorithm for HRV screening (VariScreen) in excluding HRVs were evaluated and compared with those of expanded Baveno VI criteria (LSM <25 kPa and PLT >110×109/L, EB6C); PLT >150×109/L and model for end-stage liver disease score = 6 (P150M6 criterion); PLT >120×109/L and albumin >36 g/L (P120A36 criterion); and albumin-bilirubin (ALBI) grade and PLT score (ALBI-PLT score). Among the enrolled patients, 43 (13.9%) had HRVs. The area under the receiver operating characteristic curve of PLER for predicting HRVs (0.771, 95% confidence interval, 0.720–0.817) was significantly higher than that for PLT and LSM (p < 0.01). PLER was an independent risk factor for HRVs. VariScreen, PLEASE, and PLER could spare 20 (6.5%), 91 (29.4%), and 60 (19.4%) endoscopies, with 0, 3 (3.3%), and 1 (1.7%) HRVs missed, respectively. The EB6C and P120A36 criteria could spare 45 (14.5%) and 36 (11.6%) endoscopies, with 1 (2.2%) and 1 (2.8%) HRVs missed, respectively. The P150M6 criterion and ALBI-PLT score missed 6.8% and 10.3% of HRVs, respectively. We found that PLER performed better than other non-invasive tests. VariScreen secured the screening of HRVs in patients with HBV-related cirrhosis beyond Baveno VI criteria.

Modified and alternative Baveno VI criteria based on age for ruling out high-risk varices in patients with compensated cirrhosis

BackgroundThe Baveno VI criteria (B6C) have been recommended to screen high-risk varices (HRV) in patients with liver cirrhosis to avoid the use of esophagogastroduodenoscopy (EGD). Due to conservative nature of B6C and the general unavailability of transient elastography in the medical institutions, clinical application of B6C is restricted. We aimed to optimize B6C and attempted to replace the liver stiffness (LS) score with other parameters that could help patients avoid EGD.MethodsA total of 1,188 patients with compensated cirrhosis were analyzed and divided into the training cohort (TC) and validating cohort (VC) by the split-sample method. Variables were selected to develop new criteria in the TC before verification in the VC.ResultsThe parameters of age ≥ 50 years, LS, platelet count (PLT), and spleen area (SA) were independently associated with HRV. The risk of HRV was 2.39 times greater in patients over 50 years, hence alternative B6C (AB6C) and modified B6C (MB6C) criteria were built based on age. MB6C was built by adjusting the cut-off value of LS and PLT (patients aged < 50 years with PLT > 100 × 109/L and LS < 30 kPa; patients aged ≥ 50 years with a combined PLT > 125 × 109/L and LS < 20 kPa). MB6C helped avoid EGD in 310 (51.2%) patients, whereas 7 (2.3%) cases of HRV were missed. The predicting performance HRV showed no statistical difference between PLT, SA, or LS. SA was selected to replace LS and in the built AB6C (patients aged < 50 years with PLT > 100 × 109/L and SA < 55 cm2; patients aged ≥ 50 years with a combined PLT > 125 × 109/L and SA < 44 cm2). Using AB6C avoided 297 (49.1%) EGDs with a total of 8 (2.7%) cases of HRV that were missed.ConclusionsOur novel MB6C and AB6C were stratified by age and provided excellent performance for ruling out HRV, which performed better than B6C and EB6C (expanded B6C) in helping to avoid EGD screening.Clinical trial registration numberChiCTR-DDD-17013845.

2D-Shear Wave Elastography in Predicting Esophageal Varices in Patients with Compensated Liver Cirrhosis

Background: Current guidelines require endoscopic screening for esophageal varices. It is a costly and invasive procedure. So, there has always been a search for non-invasive measures that can predict the varices obviating the use of endoscopy. We tried to see whether 2D-Shear wave elastography (2D-SWE) measurements could predict the presence of esophageal varices and high-risk esophageal varices in patients with compensated cirrhosis. Aim: To investigate the diagnostic performance of 2D-SWE in predicting the presence of esophageal varices and high-risk varices in patients with compensated cirrhosis and to compare the diagnostic capabilities of 2D-SWE with those of transient elastography(TE), and other non-invasive parameters. Methods: 108 patients with compensated cirrhosis undergoing B-mode, 2D-SWE, TE, and endoscopy were enrolled. Comparisons of the accuracy of prediction between groups were made by AUROCs. Regression analysis was performed for the multiple variables. Results: There were 64 males and 44 females, with a mean age of 51.73 ± 11.35 years. NASH(40%) and Alcohol(27%) were the main etiologies. Esophageal varices were found in 63 patients. 36 had high-risk varices. The AUROC value of 2D- SWE(0.967) was comparable to that of TE(0.961) but significantly higher than other non-invasive parameters(platelet count, spleen diameter, platelet count/spleen diameter ratio, FIB-4, APRI). 2D-SWE had 92.1% sensitivity, 88.7% specificity, 90.6% PPV, and 88.6% NPV for predicting the presence of varices at an optimal cut-off value > 21.1kPa, and 91.7% sensitivity, 88.6% specificity, 80.2 % PPV, and 95.1% NPV for predicting high-risk varices at an optimal cut-off value > 24.6 kPa. No patient with 2dSWE value <20.3 kPa had varices. Conclusion: In patients with compensated cirrhosis, liver stiffness measured by 2D- SWE is an effective non-invasive diagnostic tool for predicting the presence of esophageal varices and high-risk varices. The diagnostic performance of 2D-SWE is similar to that of TE, but better than other non-invasive parameters.

Liver stiffness by two-dimensional shear wave elastography for screening high-risk varices in patients with compensated advanced chronic liver disease.

To investigate the usefulness of the criteria with liver stiffness (LS) measured by two-dimensional shear wave elastography (2D-SWE) and platelet count (PLT) for ruling out high-risk varices in patients with compensated advanced chronic liver disease (cACLD). A total of 661 patients with cACLD had successfully undergone 2D-SWE and endoscopy screening. We analyzed risk factors for the presence of high-risk varices and compared proportions of patients who were spared endoscopy when used the predicting criteria with LS (ranged from 16 to 25kPa) and PLT (ranged from 80 × 109/L to 150 × 109/L). PLT, albumin, LS were found to be independent predictors of high-risk varices. The LS values for ruling out and ruling in high-risk varices were 14.0kPa and 24.8kPa, respectively. When the Baveno VI criteria LS < 20kPa and PLT > 150 × 109/L were used, the high-risk varices miss rate was 2.1%, while the saved endoscopy rate only was 19.2%. The new criteria that LS < 16kPa and PLT > 100 × 109/L saved 30.4-34.6% endoscopy with 0-3.2% high-risk varices miss rate in the subgroup analysis stratified according to the types of underlying liver disease. The Baveno VI criteria can be applied to LS measurement by 2D-SWE. The new criteria that LS < 16kPa and PLT > 100 × 109/L could be a potential model to spare more endoscopy screening with < 5% high-risk varices miss rate. • LS measured by 2D-SWE is reliable predictive factor for predicting all-size varices and high-risk varices in patients with compensated advanced chronic liver disease. • LS measured by 2D-SWE < 16kPa and PLT > 100 × 109 /L, which can spare more endoscopy than Baveno VI criteria with < 5% high-risk varices miss rate. • The Baveno VI criteria can be applied to LS measurement by 2D-SWE.

The Combination of Shear Wave Elastography and Platelet Counts Can Effectively Predict High-Risk Varices in Patients with Hepatitis B-Related Cirrhosis.

Background Baveno VI criteria, based on liver stiffness (LS) measured by transient elastography and platelet counts (PLT), have been proposed to avoid unnecessary endoscopy screening for high-risk varices (HRVs). However, the cut-off value of LS measured by 2D-SWE and PLT to predict HRVs in compensated hepatitis B-related cirrhotic patients remains unknown. Aims To prospectively analyze the cut-off of the combination of LS measured by 2D-SWE and PLT in predicting HRVs and the influence of antiviral therapies in its efficacy. Methods Serum parameters, LS, and endoscopy results were obtained from 160 compensated hepatitis B-related cirrhotic patients. The accuracy of the combined algorithm was assessed in the whole cohort and subgroups with or without consecutive antiviral therapies in the past 6 months. Results In the whole cohort, the optimal cut-off value of LS for HRVs was 14.5 kPa. Patients with a LS value < 14.5 kPa with a PLT value > 110 × 109/L can be excluded from HRVs (NPV = 0.99, endoscopy saved rates = 0.68). Conversely, a LS value of ≥14.5 kPa and a PLT value of ≤110 × 109/L indicated HRVs, with accurate rates of 82.35%, and 10.63% of patients can avoid additional endoscopy screening. Moreover, antiviral therapy had no significant effect on the accuracy and rates saved from further endoscopy screening, when comparing patients with or without antiviral therapies (all p values > 0.05). Conclusions The combination of LS (14.5 kPa) measured by 2D-SWE and PLT (110 × 109/L) can predict HRVs accurately in compensated hepatitis B-related cirrhotic patients without significant interference of antiviral therapy histories.

From the Editor's Desk...

From the Editor's Desk...

Development and Validation of an Easy-to-Use Risk Scoring System for Screening High-Risk Varices in Patients with HBV-Related Compensated Advanced Chronic Liver Disease

BackgroundA large portion of patients with compensated advanced chronic liver disease (cACLD) do not have varices or only have low risk varices.AimsTo create and validate an easy-to-use risk scoring system to identify high-risk varices (HRV) and spare esophagogastroduodenoscopy (EGD) in patients with hepatitis B virus (HBV)-related cACLD.MethodsIn total, 334 patients with HBV-related cACLD who had undergone routine laboratory tests and ultrasound examination were enrolled. Multivariate logistic regression analysis was used to determine which variables were the independent risk factors for the presence of HRV, so as to establish the scoring system for screening HRV. The criteria were tested in a training cohort with 221 patients and validated in a validation cohort with 113 patients.ResultsIn the training cohort, the prevalence of HRV was 29.5%. Albumin (ALB) [OR 0.83; 95% confidence index (CI) 0.77–0.90; P < 0.0001], platelet count (PLT) (OR 0.96, 95% CI 0.96–0.99; P < 0.0001) and portal vein diameter (OR 1.40; 95% CI 1.15–1.71; P = 0.001) were independent risk factors for the presence of HRV. The negative predictive value was > 95%, when albumin-platelet-portal vein diameter varices scores (APP score) were < 0.24. One hundred twenty-five of 221 (56.6%) patients met an APP score < 0.24 with a 4.8% HRV miss rate. In the validation cohort, 59 of 113 (51.3%) patients met the APP score < 0.24 with a 1.7% HRV miss rate.ConclusionsAPP score is a potential model for safely screening HRV and sparing EGDs in patients with HBV-related cACLD.