Liver stiffness and platelet count to assess the risk of bleeding from esophageal and gastric varices in liver cirrhosis

Abstract

Background The Baveno VI portal hypertension consensus recommended that liver stiffness measurement (LSM) < 20kPa and platelet count (PLT) > 150×109/L may avoid screening endoscopy in 40% of patients with compensated cirrhosis. We aimed to use transient elastography (TE) to measure liver stiffness, combined with PLT to assess the risk of bleeding from esophageal and gastric varices in patients with liver cirrhosis, and to establish a new standard for Chinese patients. Methods Adult patients with compensated liver cirrhosis treated in 8 clinical research centers from 2018 to 2020 were enrolled and randomly divided into the training cohort and the validation cohort. Patients from the training cohort were used to study the performance of different PLT and LSM, to ensure great endoscopic avoidance rate and very low varicose veins need to be treated (VNT) missed rate. At the same time, the new standard was verified in the validation cohort patients. Results A total of 260 patients (166(63.8%) hepatitis B and 229 (88.07%) Child-Pugh class A) were analyzed. In the training cohort (n = 137) with hepatitis B as the main etiology (63.8%), the LSM < 25kPa and PLT > 120×109/L were the best standards. Under this standard, 23.4% of patients could avoid unnecessary endoscopy screening, and 3.1% of patients missed VNT. In the validation cohort (n = 123), under the TOUCH standard, 24.4% of patients could avoid screening endoscopy, and the risk of missed VNT was within an acceptable range (3.4%). Conclusions The new standard based on instantaneous elastography technology could identify patients with compensatory cirrhosis with low risk of varicose veins and some patients may avoid screening endoscopy.