Non-invasive model for predicting high-risk esophageal varices based on liver and spleen stiffness

Abstract

BACKGROUND Acute bleeding due to esophageal varices (EVs) is a life-threatening complication in patients with cirrhosis. The diagnosis of EVs is mainly through upper gastrointestinal endoscopy, but the discomfort, contraindications and complications of gastrointestinal endoscopic screening reduce patient compliance. According to the bleeding risk of EVs, the Baveno VI consensus divides varices into high bleeding risk EVs (HEVs) and low bleeding risk EVs (LEVs). We sought to identify a non-invasive prediction model based on spleen stiffness measurement (SSM) and liver stiffness measurement (LSM) as an alternative to EVs screening. AIM To develop a safe, simple and non-invasive model to predict HEVs in patients with viral cirrhosis and identify patients who can be exempted from upper gastrointestinal endoscopy. METHODS Data from 200 patients with viral cirrhosis were included in this study, with 140 patients as the modelling group and 60 patients as the external validation group, and the EVs types of patients were determined by upper gastrointestinal endoscopy and the Baveno VI consensus. Those patients were divided into the HEVs group (66 patients) and the LEVs group (74 patients). The effect of each parameter on HEVs was analyzed by univariate and multivariate analyses, and a non-invasive prediction model was established. Finally, the discrimination ability, calibration ability and clinical efficacy of the new model were verified in the modelling group and the external validation group. RESULTS Univariate and multivariate analyses showed that SSM and LSM were associated with the occurrence of HEVs in patients with viral cirrhosis. On this basis, logistic regression analysis was used to construct a prediction model: Ln [P/(1-P)] = -8.184 -0.228 × SSM + 0.642 × LSM. The area under the curve of the new model was 0.965. When the cut-off value was 0.27, the sensitivity, specificity, positive predictive value and negative predictive value of the model for predicting HEVs were 100.00%, 82.43%, 83.52%, and 100%, respectively. Compared with the four prediction models of liver stiffness-spleen diameter to platelet ratio score, variceal risk index, aspartate aminotransferase to alanine aminotransferase ratio, and Baveno VI, the established model can better predict HEVs in patients with viral cirrhosis. CONCLUSION Based on the SSM and LSM measured by transient elastography, we established a non-invasive prediction model for HEVs. The new model is reliable in predicting HEVs and can be used as an alternative to routine upper gastrointestinal endoscopy screening, which is helpful for clinical decision making.

Measurement of portal vein indices and splenic index by ultrasound and their association with gastroesophageal varices in cirrhosis of liver

“…Earlier screening of esophageal varices in cirrhotic patients with prophylactic and interventional treatment can reduce the incidence of variceal bleeding and reduce morbidity and mortality. Noninvasive radiological, clinical, or laboratory parameters can be used to predict the presence of esophageal varices 16 . This study was done to establish the role of the splenic index and portal vein indices in predicting gastroesophageal varices in cirrhotic patients.…”

Enhancing liver cirrhosis varices and CSPH risk prediction with spleen stiffness measurement using 100-Hz probe

“…The SSM measurements were conducted by two physicians with extensive experience in over 100 SSM cases. The criteria used for spleen stiffness measurement were similar to those employed for liver stiffness evaluation, requiring a minimum of 10 measurements, a success rate of at least 60%, and an interquartile range (IQR) less than 30% of the median value 13,28,29 . Ultrasound examinations were performed to measure the longitudinal spleen length, thickness, and width by three experienced physicians with more than 10 years of pertinent experience.…”

Improved Applicability and Diagnostic Accuracy of the Novel Spleen-Dedicated Transient Elastography Device for High-Risk Esophageal Varices

“…Invasiveness, high price and limited availability of HVPG have imposed the need to investigate alternative methods for assessing the severity of PH, such as elastographic techniques [8]. The gold standard for EV diagnosis is esophagogastroduodenoscopy (EGD), whereby EVs of any size and high-risk esophageal varices (HRV) are present in around 40-50% and 15-20% of patients with compensated advanced chronic Diagnostics 2024, 14, 743 2 of 12 liver disease (cACLD), respectively, making endoscopy unnecessary in a significant number of patients [9,10]. In the initial stage of development, PH is mostly influenced by the accumulation of fibrotic tissue within the liver; thus, liver stiffness measurement (LSM) has been demonstrated as the reliable diagnostic method to differentiate between patients according to the presence or absence of CSPH [11].…”