RESIST-HCV Criteria to Monitor Progression of Low-Risk Esophageal Varices in Patients With Compensated Cirrhosis After HCV Eradication: The SIMPLE Study

Abstract

INTRODUCTION:Noninvasive criteria to predict the progression of low-risk esophageal varices (EV) in patients with compensated hepatitis C virus (HCV) cirrhosis after sustained virological response (SVR) by direct-acting antivirals (DAAs) are lacking. Our aim was to assess the diagnostic performance of Rete Sicilia Selezione Terapia–HCV (RESIST-HCV) criteria for EV progression compared with elastography-based criteria (Baveno VI, Expanded Baveno VI, and Baveno VII-HCV criteria).METHODS:All consecutive patients observed at 3 referral centers with compensated HCV cirrhosis with or without F1 EV who achieved sustained virological response by DAAs were classified at last esophagogastroduodenoscopy (EGDS) as RESIST-HCV low risk (i.e., low probability of high-risk varices [HRV]) if platelets were >120 × 109/L and serum albumin >3.6 g/dL or RESIST-HCV high risk (i.e., high probability of HRV) if platelets were <120 × 109/L or serum albumin <3.6 g/dL. The primary outcome was the progression to HRV. The area under the receiver operating characteristic curve and decision curve analysis of noninvasive criteria were calculated.RESULTS:The cohort consisted of 353 patients in Child-Pugh class A (mean age 67.2 years, 53.8% males). During a mean follow-up of 44.2 months, 34 patients (9.6%, 95% CI 6.7%–13.5%) developed HRV. At the last EGDS, 178 patients (50.4%) were RESIST-low risk, and 175 (49.6%) were RESIST-high risk. RESIST-HCV criteria showed the highest area under the receiver operating characteristic curve (0.70, 95% confidence interval 0.65–0.75), correctly sparing the highest number of EGDS (54.3%), with the lowest false-positive rate (45.7%), compared with elastography-based criteria. Decision curve analysis showed that RESIST-HCV had higher clinical utility than elastography-based criteria.DISCUSSION:Biochemical-based RESIST-HCV criteria are useful to easily predict HRV development after HCV eradication by DAAs in patients with compensated cirrhosis and low-risk EV.

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“…Besides, our data showed that the risk of progression in PHT varies between patients with medium varices and small varices. Our findings indicate that the progression rate of small EV is low, with a rate of 5.0%, which is consistent with previous studies (18,30). However, the progression rate of medium EV increased to 52.2% even when etiology control was well-managed.…”

Hypergammaglobulinemia before Starting DAA Therapy Is A Strong Predictor of Disease Progression in Cirrhotic Patients Even after HCV Clearance

“…Finally, 10 (3.1%) patients without evidence of esophageal varices at baseline developed them during follow-up without any other signs of progression of liver disease. According to a recent study, we also evaluate the reduction of portal hypertension by applying the "resist HCV criteria": we stratified the patients on the basis of RESIT HCV score, and our results confirm that Resist-HCV HR score was associated with a progression of esophageal varices 32 .…”

“…Finally, we also stratified the patients on the basis of resisting HCV scores [RESIST-HCV low risk (LR) if they had PLT count >120,000/L and serum albumin 3.6 g/dL or RESIST-HCV high risk (HR) if they had PLT count <120,000/L or serum albumin <3.6 g/dL] to Monitor Progression of Esophageal Varices [30][31][32].…”

Oesophageal varices predict complications in compensated advanced non-alcoholic fatty liver disease

“…As the area under the receiving operating characteristic curve focuses only on the predictive accuracy of a model, not considering cases in which a false-negative result is more harmful than a false-positive result, we also performed a decision curve analysis (DCA) for identifying the threshold probabilities for which the use of non-invasive criteria translates into the maximum net benefit of detecting high-risk OV. [21] , [22] , [23] , [24] …”