Prediction of the varices needing treatment with non-invasive tests in patients with compensated advanced chronic liver disease

Han Ah Lee, Seung Up Kim, Yeon Seok Seo, Young-Sun Lee, Seong Hee Kang, Young Kul Jung, Moon Young Kim, Ji Hoon Kim, Sang Gyune Kim, Ki Tae Suk, Soung Won Jung, Jae Young Jang, Hyonggin An, Hyung Joon Yim, Soon-Ho Um

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Backgrounds & Aims: The Baveno VI guidelines proposed criteria including liver stiffness (LS) and platelet count to avoid screening endoscopy in patients with compensated advanced chronic liver disease (cACLD). This study was performed to validate the Baveno IV criteria and to compare its diagnostic accuracy with other non-invasive models. Methods: Patients with cACLD who underwent laboratory tests, upper gastrointestinal endoscopy and abdominal ultrasound within 6 months of transient elastography were included. Results: A total of 1218 patients with cACLD were included. VNT occurred in 249 patients (20.4%). With the Baveno VI criteria, the VNT miss rate was 1.9% with a 25.7% saved endoscopy rate. Using two criteria of LS <20 kPa and platelet count >110 × 10 9  cells/L or LS <25 kPa and platelet count >120 × 10 9  cells/L, the saved endoscopy rate was 39.1% while maintaining the VNT miss rate <5%. The optimal LS and platelet count-based criteria for predicting VNT differed according to the underlying liver disease. The area under the receiver operating characteristic curve of LS-spleen diameter to platelet score (LSPS) was 0.780 (95% confidence interval: 0.774-0.820), which was significantly higher than other models. The optimal cut-off value of the LSPS for predicting VNT was 1.47. Conclusion: Liver stiffness and platelet count-based criteria are useful for discriminating patients with very low risk of having VNT among patients with cACLD and are partly affected by the type of underlying liver disease. Conversely, the LSPS is a predictor of VNT in patients with cACLD regardless of the type of underlying liver disease.

Original languageEnglish
JournalLiver International
DOIs
Publication statusPublished - 2019 Jan 1

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Varicose Veins
Liver Diseases
Chronic Disease
Liver
Platelet Count
Endoscopy
Blood Platelets
Spleen
Therapeutics
Elasticity Imaging Techniques
Gastrointestinal Endoscopy
ROC Curve
Guidelines
Confidence Intervals

Keywords

  • platelet
  • prophylaxis
  • spleen
  • transient elastography
  • varices

ASJC Scopus subject areas

  • Hepatology

Cite this

Prediction of the varices needing treatment with non-invasive tests in patients with compensated advanced chronic liver disease. / Lee, Han Ah; Kim, Seung Up; Seo, Yeon Seok; Lee, Young-Sun; Kang, Seong Hee; Jung, Young Kul; Kim, Moon Young; Kim, Ji Hoon; Kim, Sang Gyune; Suk, Ki Tae; Jung, Soung Won; Jang, Jae Young; An, Hyonggin; Yim, Hyung Joon; Um, Soon-Ho.

In: Liver International, 01.01.2019.

Research output: Contribution to journalArticle

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title = "Prediction of the varices needing treatment with non-invasive tests in patients with compensated advanced chronic liver disease",
abstract = "Backgrounds & Aims: The Baveno VI guidelines proposed criteria including liver stiffness (LS) and platelet count to avoid screening endoscopy in patients with compensated advanced chronic liver disease (cACLD). This study was performed to validate the Baveno IV criteria and to compare its diagnostic accuracy with other non-invasive models. Methods: Patients with cACLD who underwent laboratory tests, upper gastrointestinal endoscopy and abdominal ultrasound within 6 months of transient elastography were included. Results: A total of 1218 patients with cACLD were included. VNT occurred in 249 patients (20.4{\%}). With the Baveno VI criteria, the VNT miss rate was 1.9{\%} with a 25.7{\%} saved endoscopy rate. Using two criteria of LS <20 kPa and platelet count >110 × 10 9  cells/L or LS <25 kPa and platelet count >120 × 10 9  cells/L, the saved endoscopy rate was 39.1{\%} while maintaining the VNT miss rate <5{\%}. The optimal LS and platelet count-based criteria for predicting VNT differed according to the underlying liver disease. The area under the receiver operating characteristic curve of LS-spleen diameter to platelet score (LSPS) was 0.780 (95{\%} confidence interval: 0.774-0.820), which was significantly higher than other models. The optimal cut-off value of the LSPS for predicting VNT was 1.47. Conclusion: Liver stiffness and platelet count-based criteria are useful for discriminating patients with very low risk of having VNT among patients with cACLD and are partly affected by the type of underlying liver disease. Conversely, the LSPS is a predictor of VNT in patients with cACLD regardless of the type of underlying liver disease.",
keywords = "platelet, prophylaxis, spleen, transient elastography, varices",
author = "Lee, {Han Ah} and Kim, {Seung Up} and Seo, {Yeon Seok} and Young-Sun Lee and Kang, {Seong Hee} and Jung, {Young Kul} and Kim, {Moon Young} and Kim, {Ji Hoon} and Kim, {Sang Gyune} and Suk, {Ki Tae} and Jung, {Soung Won} and Jang, {Jae Young} and Hyonggin An and Yim, {Hyung Joon} and Soon-Ho Um",
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T1 - Prediction of the varices needing treatment with non-invasive tests in patients with compensated advanced chronic liver disease

AU - Lee, Han Ah

AU - Kim, Seung Up

AU - Seo, Yeon Seok

AU - Lee, Young-Sun

AU - Kang, Seong Hee

AU - Jung, Young Kul

AU - Kim, Moon Young

AU - Kim, Ji Hoon

AU - Kim, Sang Gyune

AU - Suk, Ki Tae

AU - Jung, Soung Won

AU - Jang, Jae Young

AU - An, Hyonggin

AU - Yim, Hyung Joon

AU - Um, Soon-Ho

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Backgrounds & Aims: The Baveno VI guidelines proposed criteria including liver stiffness (LS) and platelet count to avoid screening endoscopy in patients with compensated advanced chronic liver disease (cACLD). This study was performed to validate the Baveno IV criteria and to compare its diagnostic accuracy with other non-invasive models. Methods: Patients with cACLD who underwent laboratory tests, upper gastrointestinal endoscopy and abdominal ultrasound within 6 months of transient elastography were included. Results: A total of 1218 patients with cACLD were included. VNT occurred in 249 patients (20.4%). With the Baveno VI criteria, the VNT miss rate was 1.9% with a 25.7% saved endoscopy rate. Using two criteria of LS <20 kPa and platelet count >110 × 10 9  cells/L or LS <25 kPa and platelet count >120 × 10 9  cells/L, the saved endoscopy rate was 39.1% while maintaining the VNT miss rate <5%. The optimal LS and platelet count-based criteria for predicting VNT differed according to the underlying liver disease. The area under the receiver operating characteristic curve of LS-spleen diameter to platelet score (LSPS) was 0.780 (95% confidence interval: 0.774-0.820), which was significantly higher than other models. The optimal cut-off value of the LSPS for predicting VNT was 1.47. Conclusion: Liver stiffness and platelet count-based criteria are useful for discriminating patients with very low risk of having VNT among patients with cACLD and are partly affected by the type of underlying liver disease. Conversely, the LSPS is a predictor of VNT in patients with cACLD regardless of the type of underlying liver disease.

AB - Backgrounds & Aims: The Baveno VI guidelines proposed criteria including liver stiffness (LS) and platelet count to avoid screening endoscopy in patients with compensated advanced chronic liver disease (cACLD). This study was performed to validate the Baveno IV criteria and to compare its diagnostic accuracy with other non-invasive models. Methods: Patients with cACLD who underwent laboratory tests, upper gastrointestinal endoscopy and abdominal ultrasound within 6 months of transient elastography were included. Results: A total of 1218 patients with cACLD were included. VNT occurred in 249 patients (20.4%). With the Baveno VI criteria, the VNT miss rate was 1.9% with a 25.7% saved endoscopy rate. Using two criteria of LS <20 kPa and platelet count >110 × 10 9  cells/L or LS <25 kPa and platelet count >120 × 10 9  cells/L, the saved endoscopy rate was 39.1% while maintaining the VNT miss rate <5%. The optimal LS and platelet count-based criteria for predicting VNT differed according to the underlying liver disease. The area under the receiver operating characteristic curve of LS-spleen diameter to platelet score (LSPS) was 0.780 (95% confidence interval: 0.774-0.820), which was significantly higher than other models. The optimal cut-off value of the LSPS for predicting VNT was 1.47. Conclusion: Liver stiffness and platelet count-based criteria are useful for discriminating patients with very low risk of having VNT among patients with cACLD and are partly affected by the type of underlying liver disease. Conversely, the LSPS is a predictor of VNT in patients with cACLD regardless of the type of underlying liver disease.

KW - platelet

KW - prophylaxis

KW - spleen

KW - transient elastography

KW - varices

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