Liver stiffness and serum markers for excluding high-risk varices in patients who do not meet Baveno VI criteria

Zhou, Hong; Long, Jun; Hu, Han Hwa; Tian, Caiyun; Lin, Shide

doi:10.3748/wjg.v25.i35.5323

Cited by 13 publications

(10 citation statements)

References 34 publications

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“…Lok index was proved to be associated with portal hypertension[ 40 ]. In a retrospective study including 132 patients, Zhou et al [ 41 ] found that in patients who did not meet Baveno VI criteria, Lok index could spare 24.2% of gastroscopy screening without missing high-risk varices which were defined as EV with red wale signs[ 42 ]. However, none of PSR, King’s score, or Lok index can take full advantage of imaging examination in the prediction of EV.…”

Section: Discussionmentioning

confidence: 99%

Liver fibrosis index-based nomograms for identifying esophageal varices in patients with chronic hepatitis B related cirrhosis

Guo

et al. 2020

WJG

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BACKGROUND Esophageal varices (EV) are the most fatal complication of chronic hepatitis B (CHB) related cirrhosis. The prognosis is poor, especially after the first upper gastrointestinal hemorrhage. AIM To construct nomograms to predict the risk and severity of EV in patients with CHB related cirrhosis. METHODS Between 2016 and 2018, the patients with CHB related cirrhosis were recruited and divided into a training or validation cohort at The First Affiliated Hospital of Wenzhou Medical University. Clinical and ultrasonic parameters that were closely related to EV risk and severity were screened out by univariate and multivariate logistic regression analyses, and integrated into two nomograms, respectively. Both nomograms were internally and externally validated by calibration, concordance index (C-index), receiver operating characteristic curve, and decision curve analyses (DCA). RESULTS A total of 307 patients with CHB related cirrhosis were recruited. The independent risk factors for EV included Child-Pugh class [odds ratio (OR) = 7.705, 95% confidence interval (CI) = 2.169-27.370, P = 0.002], platelet count (OR = 0.992, 95%CI = 0.984-1.000, P = 0.044), splenic portal index (SPI) (OR = 3.895, 95%CI = 1.630-9.308, P = 0.002), and liver fibrosis index (LFI) (OR = 3.603, 95%CI = 1.336-9.719, P = 0.011); those of EV severity included Child-Pugh class (OR = 5.436, 95%CI = 2.112-13.990, P < 0.001), mean portal vein velocity (OR = 1.479, 95%CI = 1.043-2.098, P = 0.028), portal vein diameter (OR = 1.397, 95%CI = 1.021-1.912, P = 0.037), SPI (OR = 1.463, 95%CI = 1.030-2.079, P = 0.034), and LFI (OR = 3.089, 95%CI = 1.442-6.617, P = 0.004). Two nomograms (predicting EV risk and severity, respectively) were well-calibrated and had a favorable discriminative ability, with C-indexes of 0.916 and 0.846 in the training cohort, respectively, higher than those of other predictive indexes, like LFI (C-indexes = 0.781 and 0.738), SPI (C-indexes = 0.805 and 0.714), ratio of platelet count to spleen diameter (PSR) (C-indexes = 0.822 and 0.726), King’s score (C-indexes = 0.694 and 0.609), and Lok index (C-indexes = 0.788 and 0.700). The areas under the curves (AUCs) of the two nomograms were 0.916 and 0.846 in the training cohort, respectively, higher than those of LFI (AUCs = 0.781 and 0.738), SPI (AUCs = 0.805 and 0.714), PSR (AUCs = 0.822 and 0.726), King’s score (AUCs = 0.694 and 0.609), and Lok index (AUCs = 0.788 and 0.700). Better net benefits were shown in the DCA. The results were validated in the validation cohort. CONCLUSION Nomograms incorporating clinical and ultrasonic variables are efficient in noninvasively predicting the risk and severity of EV....

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Section: Discussionmentioning

confidence: 99%

Liver fibrosis index-based nomograms for identifying esophageal varices in patients with chronic hepatitis B related cirrhosis

Guo

et al. 2020

WJG

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“…In our previous study [ 40 ], we found that ALT was independently negatively associated with the prevalence of HRV in patients with HBV-related compensated cirrhosis who did not fulfill the Baveno VI criteria. In patients with ALT or TBil ≥ 2 ULN, the Lok index and PLT yielded an area under the receiver operating curve of 0.814 and 0.741, respectively.…”

Section: Refinement Of the Baveno VI Criteriamentioning

confidence: 95%

“…A positive correlation between the proportion of NAFLD and rate of spared endoscopy was reported [ 29 ]. In a previous study, we found that, among patients with HBV-related compensated liver cirrhosis who did not meet the Baveno VI criteria, the prevalence of HRV was significantly lower in those with ALT or total bilirubin (TBil) ≥ 2 upper limit of normal (ULN) (14.3%) than in those with both ALT and TBil < 2 ULN (34.1%) [ 40 ]. These findings suggested that the concomitant liver inflammation may falsely increase LSM, making it difficult for patients to fulfill the Baveno VI criteria and decreasing the rate of spared gastroscopies.…”

Section: Limitation Of the Baveno VI Criteriamentioning

confidence: 99%

Validation and Refinement of the Baveno VI Criteria for Ruling Out High-Risk Varices

Zhou

Tian³

et al. 2020

Gastroenterology Research and Practice

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In the past decade, numerous studies have evaluated the roles of noninvasive methods for diagnosing or excluding varices and high-risk varices in patients with liver cirrhosis. The Baveno VI criteria recommend the use of a simple algorithm based on a liver stiffness measurement < 20 kPa through transient elastography and a platelet count > 150 × 10 9 / L for ruling out high-risk varices in patients with compensated advanced chronic liver disease. A large number of studies have validated the clinical usefulness of Baveno VI criteria for excluding high-risk varices. Several strategies have been proposed to refine the Baveno VI criteria; however, currently there is no review to summarize the diagnostic accuracy and limitations of the Baveno VI criteria after extensive validation. In this review, we summarize the diagnostic accuracy and limitations of the Baveno VI criteria after extensive validation. We also discuss methods to refine these criteria.

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“…For example, Ma et al [26] showed that FIB-4 and Lok' s model were the most effective models for distinguishing significant and extensive fibrosis. Zhou et al [27] found that a Lok index cut-off value of 0.4531 could further spare 24.2% of gastroscopies without missing high-risk varices (HRVs) [27] . Since this is a fibrosis marker, Mobarak et al [28] found that it was also able to predict HCC development.…”

Section: Lok Index and Forns Indexmentioning

confidence: 99%

Non-invasive tests for the prediction of post-hepatectomy liver failure in the elderly

Marasco¹,

Colecchia²,

Milandri³

et al. 2020

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Post-hepatectomy liver failure (PHLF) is associated with great morbidity and mortality after resection of hepatocellular carcinoma. Previous studies have underlined that advanced age could be a potential factor influencing post-operative complications and long-term survival. In the past, candidates for resection were based on the Child-Pugh classification, the predictive value of which was rather low. The selection of patients undergoing resection in Western countries is based on the assessment of portal hypertension (PH), which is clinically assessed by measurement of the hepatic venous pressure gradient, an invasive and costly process. Thus, there have been several attempts to identify the best non-invasive test (NIT) to accurately predict PHLF. Most biochemical NITs for the prediction of PHLF are focused on evaluation of underlying liver cirrhosis and PH. Amongst them, FIB-4, which also includes the patient's age, seems to have more robust supporting results. In Europe and the USA., the most tested and reliable NIT for predicting PHLF is the evaluation of liver stiffness measurement, which is also influenced by age. Imaging parameters are promising tools which are used only in specialized centers however, and when available. Liver volume parameters, as well as contrastenhanced data, demonstrate good accuracy in predicting PHLF. In this scenario, the evaluation of sarcopenia and bone mineral density through contextual imaging allows the delineation of PHLF in at-risk elderly patients. Further studies focused on parameters for the evaluation of PHLF in elderly patients are needed.

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Liver stiffness and serum markers for excluding high-risk varices in patients who do not meet Baveno VI criteria

Cited by 13 publications

References 34 publications

Liver fibrosis index-based nomograms for identifying esophageal varices in patients with chronic hepatitis B related cirrhosis

Liver fibrosis index-based nomograms for identifying esophageal varices in patients with chronic hepatitis B related cirrhosis

Validation and Refinement of the Baveno VI Criteria for Ruling Out High-Risk Varices

Non-invasive tests for the prediction of post-hepatectomy liver failure in the elderly

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