Including Ratio of Platelets to Liver Stiffness Improves Accuracy of Screening for Esophageal Varices That Require Treatment

Berger, A; Ravaioli, Federico; Farcau, Oana; Festi, Davide; Ştefănescu, Horia; Buisson, F.; Ganne‐Carrié, Nathalie; Berzigotti, Annalisa; Petta, Salvatore; Huvelin, Sylvie Sacher; Valla, Dominique; Bureau, Christophe; Olivier, Anne; Oberti, Frédéric; Boursier, Jérôme; Galmiche, Jean Paul; Vinel, Jean Pierre; Duburque, Clotilde; Attar, Alain; Archambeaud, Isabelle; Bénamouzig, Robert; Gaudric, M; Couzigou, Patrice; Planche, Lucie; Coron, Emmanuel; Hiriart, Jean‐Baptiste; Chermak, Faïza; Charbonnier, Maude; Nahon, Pierre; Marcellin, Patrick; Guyader, Dominique; Pol, Stanislas; Fontaine, Hélène; Larrey, Dominique; Lédinghen, Victor de; Ouzan, Denis; Zoulim, Fabien; Roulot, Dominique; Tran, Albert; Bronowicki, Jean–Pierre; Zarski, Jean–Pierre; Leroy, Vincent; Riachi, Ghassan; Calès, Paul; Péron, Jean‐Marie; Alric, Laurent; Bourlière, Marc; Dharancy, Sébastien; Blanc, Jean‐Frédéric; Abergel, Armand; Serfaty, Lawrence; Mallat, Ariane; Grangé, Jean‐Didier; Attali, P; Bacq, Yannick; Wartelle, Claire; Dao, Thông; Benhamou, Yves; Pilette, Christophe; Silvain, Christine; Christidis, Christos; Capron, Dominique; Thiéfin, Gérard; Hillaire, Sophie; Martino, Vincent Di

doi:10.1016/j.cgh.2020.06.022

Cited by 22 publications

(26 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Among them, PH and gastroesophageal varices are common complications of CLD. In our study, VNT prevalence was 28.5% in patients with cACLD, which is higher than those reported in literature (13.0%-20.9%) 13,18,[21][22][23] . We think it may be related to the sample size.…”

Section: Discussioncontrasting

confidence: 77%

“…Our study showed that it could spare 19.5% more gastroscopies than using the B6C. While, the VNT missed rate was 5.9%, which meant it was not safe enough, which reflecting those previous www.nature.com/scientificreports/ studies 18,36 . The AUROC of the LSPS was 0.89 in our study, and could significantly spare more gastroscopies than the other three NITs.…”

Section: Discussionmentioning

confidence: 62%

“…But similar to the EB6C, the LSPS was not safe either due to a high VNT missed rate (9.9%) 37 . Gastroscopies were spared for 45.5% of patients when using the VariScreen algorithm for ruling out VNT in patients with cACLD, and the VNT missed rate was 3.0%, which meant it was safe to be applied 18 .…”

Section: Discussionmentioning

confidence: 99%

“…Several NITs have been developed to rule out VNT, including platelet/MELD strategy 7 , the platelet-albumin criteria 8 , the LGV diameter-SS to PLT ratio index (LSPI) 9 , Platelet count/spleen diameter ratio (PSR) 10 , liver stiffness measurement (LSM) 11 , 12 , spleen stiffness measurement (SSM) 13 , 14 , the Baveno VI criteria (B6C) 15 , the expanded Baveno VI criteria (EB6C) 16 , LSM-spleen diameter (SD) to platelet ratio score (LSPS) 17 , and the VariScreen algorithm 18 , etc. Transient elastography (TE) has been proven to be an accurate and noninvasive technique for assessing hepatic fibrosis and liver cirrhosis 19 .…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Validation and comparison of non-invasive prediction models based on liver stiffness measurement to identify patients who could avoid gastroscopy

Wen

2021

Sci Rep

View full text Add to dashboard Cite

Several non‐invasive tests (NITs) based on liver stiffness measurement (LSM) have been developed to rule out varices needing treatment (VNT), including the Baveno VI criteria (B6C), the expanded Baveno VI criteria (EB6C), the LSM-spleen diameter to platelet ratio score (LSPS), and the VariScreen algorithm. We aimed to validate and compare those NITs in patients with compensated advanced chronic liver disease (cACLD). This retrospective study enrolled 354 patients with cACLD; LSM, platelet count (PLT), international normalized ratio (INR), gastroscopy and spleen diameter (SD) were collected. VNT prevalence was 28.5%. In comparison, patients with VNT included higher LSM, INR, and SD and lower PLT. Gastroscopies were spared for 27.7% of patients using the B6C with 1.0% VNT missed rate, 47.2% of patients using the EB6C with 5.9% VNT missed rate, 57.6% of patients using the LSPS with 9.9% VNT missed rate, and 45.5% of patients using the VariScreen algorithm with 3.0% VNT missed rate. Only the B6C and the VariScreen algorithm could safely avoid gastroscopies, and the VariScreen algorithm spared more gastroscopies than the B6C. The results were consistent with the previous when performed subgroup analysis. In conclusion, the VariScreen algorithm performed the best and can be used in clinical.

show abstract

Section: Discussioncontrasting

confidence: 77%

Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Validation and comparison of non-invasive prediction models based on liver stiffness measurement to identify patients who could avoid gastroscopy

Wen

2021

Sci Rep

View full text Add to dashboard Cite

show abstract

“… 73–75 However, a higher rate of missed EVs has been reported, often over the safe threshold of 5%. 76–78 This was confirmed also by a recent meta-analysis, 69 where the Expanded Baveno VI criteria showed superior specificity (51%) for HRV, but with an increased risk of missed HRVs (up to 10%).…”

Section: Part II – Non-invasive Evaluation Of Portal Hypertensionmentioning

confidence: 64%

Approaches to the Diagnosis of Portal Hypertension: Non-Invasive or Invasive Tests?

Dajti

Alemanni²,

Marasco³

et al. 2021

HMER

View full text Add to dashboard Cite

Portal hypertension is the main driver of complications in patients with advanced chronic liver disease (ACLD) and is defined by values of hepatic venous pressure gradient measurement (HVPG) >5 mmHg. Values of HVPG ≥10 mmHg determine the presence of clinically significant portal hypertension (CSPH), the main predictor of the risk of variceal bleeding, hepatic decompensation, and mortality. However, its measurement is invasive and requires high expertise, so its routine use outside third level centers or clinical trials is limited. In the last decades, several non-invasive tests (NITs) have been developed and validated for the diagnosis of portal hypertension. Among these, liver (LSM) and spleen stiffness measurement (SSM) are the most promising tools available, as they have been proven accurate to predict CSPH, high-risk esophageal varices, decompensation, and mortality in patients with ACLD. In the last Baveno VI Consensus proceedings, LSM evaluation was recommended for the first time for diagnosis of CSPH (LSM >20-25 kPa) and the screening of patients with a low probability of having high-risk varices (LSM <20 kPa and platelet count >150.000/mm 3 ). In this review, we aimed to summarize the growing evidence supporting the use of non-invasive tests for the evaluation of portal hypertension in patients with chronic liver disease.

show abstract

A strategy for varices screening based on acoustic radiation force impulse combined with platelet (CHESS2001): An alternative of Baveno VI criteria

Huang¹,

Zhao²,

He³

et al. 2022

Hepatol Commun

View full text Add to dashboard Cite

Few studies have reported on acoustic radiation force impulse (ARFI) for varices screening. Our study aimed to identify a strategy based on liver stiffness measurement (LSM) and spleen stiffness measurement (SSM) by ARFI combined with platelet count (PLT), named the ARP strategy, for ruling out high-risk varices (HRV) and avoiding unnecessary esophagogastroduodenoscopy (EGD) in patients with compensated cirrhosis. We retrospectively reviewed patients who underwent ARFI from a previous cohort (NCT04307264). Of them, patients between 2017 and 2019 composed the training cohort to develop the ARP strategy. The validation cohort consisted of others between 2015 and 2016 to validate and compare it with Baveno VI criteria about the performance for varices screening. Primary outcomes were the rates of spared EGDs and HRV missed. A total of 741 consecutive patients were included in the final analysis. Of them, 576 patients were included in the training cohort and 165 patients in the validation cohort. In the training cohort, ARP strategy was defined as LSM < 1.805 m/s or SSM < 2.445 m/s and PLT > 110 × 10 9 /L. ARP strategy could spare 234 (40.6%) EGDs with a missed HRV rate of 3.4% (8 of 234). In the validation cohort, compared with Baveno VI criteria, the ARP strategy improved the proportion of avoided EGDs (49.7% vs. 34.5%; p < 0.001) and lowered the rate of misclassified HRV (1.2% vs.3.5%; p < 0.001). Conclusion: The ARP strategy was an efficient and safe tool for varices screening in compensated cirrhosis, and it might be an auxiliary or even alternative to Baveno VI criteria.

show abstract

Including Ratio of Platelets to Liver Stiffness Improves Accuracy of Screening for Esophageal Varices That Require Treatment

Cited by 22 publications

References 23 publications

Validation and comparison of non-invasive prediction models based on liver stiffness measurement to identify patients who could avoid gastroscopy

Validation and comparison of non-invasive prediction models based on liver stiffness measurement to identify patients who could avoid gastroscopy

Approaches to the Diagnosis of Portal Hypertension: Non-Invasive or Invasive Tests?

A strategy for varices screening based on acoustic radiation force impulse combined with platelet (CHESS2001): An alternative of Baveno VI criteria

Contact Info

Product

Resources

About