Validation of PH and Varices Risk Scores for Prediction of High-Risk Esophageal Varix and Bleeding in Patients with B-Viral Cirrhosis

Abstract

Esophageal varices (EVs) can be accurately predicted using PH and varices risk scores. We aimed to validate their prognostic performances. Methods: We enrolled patients with B-viral cirrhosis as the training cohort (n = 503). Areas under receiver operating characteristic curves (AUROCs) for HEV were calculated for PH (=−5.953 + 0.188 × liver stiffness (LS) + 1.583 × sex (1:male/0:female) + 26.705 × spleen diameter/platelet count ratio) and varices (=−4.364 + 0.538 × spleen diameter −0.049 × platelet count −0.044 × LS + 0.001 × LS × platelet count) risk scores, and compared to LSPS (=LS × spleen diameter/platelet count). An independent cohort was recruited for further validation (n = 222). In the training cohort, the varices risk score showed the highest AUROC (0.926), followed by the PH risk score (0.924) and LSPS (0.924), but without any statistically significant differences. For varices risk scores ≤−1.70 and ≥1.48, a 95.0% negative predictive value (NPV) and 91.2% positive predictive value (PPV) were observed, respectively. At PH risk scores ≤2.25 and ≥7.71, 95.0% NPV and 90.0% PPV were observed, respectively. At LSPS ≤1.73 and ≥13.9, 95.3% NPV and 95.0% PPV were observed, respectively. The EV bleeding (EVB) risk during follow-up increased stepwise and significantly when stratified by PH, varices risk scores, and LSPS (all p < 0.001). In the validation cohort, NPVs were generally similar when stratified by PH (88.2%), varices risk scores (93.2%), and LSPS (88.9%); however, corresponding PPVs were suboptimal. PH and variceal risk scores are reliable for predicting HEV and future EVB. Patients with PH and varices risk scores ≤2.25 and ≤−1.70, respectively, may avoid endoscopy safely. For convenience, LSPS might be a good alternative, with comparable prognostic performance to these two models.

Noninvasive risk assessment of hepatic decompensation in patients with hepatitis B virus‐related liver cirrhosis

“…18 Spleen diameter was defined as the greatest longitudinal diameter at the splenic hilum level, as measured on a monitor using electronic calipers. 15 Endpoints. Time to hepatic decompensation was the primary endpoint of our study, with hepatocellular carcinoma (HCC) development and death as competing events.…”

“…The diagnosis of cirrhosis was made using histology if available or was diagnosed clinically as follows: (i) platelet count < 150 000/μL and ultrasonographic results suggestive of compensated cirrhosis, including a blunted, nodular liver edge accompanied by splenomegaly (> 12 cm); (ii) the presence of esophageal or gastric varices; or (iii) complications of liver cirrhosis, including hepatic encephalopathy and ascites 18 . Spleen diameter was defined as the greatest longitudinal diameter at the splenic hilum level, as measured on a monitor using electronic calipers 15 …”

“…Additional noninvasive models for detecting EVs and clinically significant portal hypertension, such as portal hypertension (PH) risk score and varices risk scores, used formulas that included the LS value, platelet count, and spleen diameter 14 . These models were modified recently by Shin et al ., where the LS‐spleen size‐to‐platelet (LSPS) was shown to be an effective model for detecting HEV 15 . Most recently, Guha et al .…”

“…14 These models were modified recently by Shin et al, where the LS-spleen size-to-platelet (LSPS) was shown to be an effective model for detecting HEV. 15 Most recently, Guha et al demonstrated a scoring system for detecting patients at high risk of decompensation by combining the albumin-bilirubin (ALBI) score with the fibrosis-4 (FIB-4) score to create the ALBI-FIB-4 scoring system. 16 Recently, Wong et al introduced the CHESS-ALARM score for predicting hepatic decompensation in patients with liver cirrhosis using age, sex, platelet count, and LS value.…”