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

Abstract

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.

Validation and Comparison of Non-Invasive Tests for the Exclusion of High-Risk Varices in Compensated Advanced Chronic Liver Disease

“…As with the meta-analysis by Stafylidou et al, our study found that the B6C had a low specificity of 38%, which resulted in a low spared OGD rate of 33.8%. The B6C in our study, however, demonstrated a high NPV and low negative LR at the expense of poor PPV and positive LR with similar findings from several other studies worldwide [24][25][26][27]. These results support the notion that the B6C is better as a screening tool in excluding HRV rather than diagnosing them.…”

A Combined Baveno VII and Spleen Stiffness Algorithm to Improve the Noninvasive Diagnosis of Clinically Significant Portal Hypertension in Patients With Compensated Advanced Chronic Liver Disease

“…In recent years, SSM has been extensively proposed as a more accurate and direct surrogate of portal hypertension than LSM, with a better diagnostic performance in diagnosing CSPH and varices in patients with cirrhosis (13,16,(18)(19)(20)(31)(32)(33). Going beyond the LSM comparison, the addition of SSM in models that include LSM and PLT has been shown to significantly improve the performance of noninvasive screening strategies for portal hypertension and its complications, without requiring additional costs or professional skills.…”

VariScreen secures the screening of high-risk varices in patients with hepatitis B virus-related cirrhosis beyond Baveno VI criteria

“…Most studies have included patients who are within and beyond Baveno VI criteria to verify the efficacy and safety of NITs in excluding HRVs. Because patients who are within Baveno VI criteria had a significantly lower prevalence of HRVs than patients who were beyond Baveno VI criteria, the different distribution of patients within and beyond Baveno VI criteria resulted in a different HRV prevalence ( Zhou et al, 2019 ; Hu and Wen, 2021 ; Calès et al, 2022 ). A recent meta-analysis found that a different HRV prevalence resulted in different performances of NITs ( Bai and Abraldes, 2022 ).…”