scholarly journals A72 NON-INVASIVE PREDICTION OF ESOPHAGEAL VARICES BY TRANSIENT ELASTOGRAPHY AND PLATELET COUNT IN PATIENTS WITH HEPATITIS B AND ADVANCED CHRONIC LIVER DISEASE: VALIDATION OF BAVENO VI AND EXPANDED BAVENO VI CRITERIA

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 37-38
Author(s):  
A Zoughlami ◽  
J Serero ◽  
G Sebastiani ◽  
M Deschenes ◽  
P Wong ◽  
...  
Keyword(s):  
Platelet Count ◽  
Liver Disease ◽  
Hepatitis B ◽  
Chronic Liver Disease ◽  
Esophageal Varices ◽  
Diagnostic Performance ◽  
Transient Elastography ◽  
Chronic Liver ◽  
Non Invasive ◽  
Chronic Hepatitis B Virus

Abstract Background Patients with compensated advanced chronic liver disease (cACLD) are at higher risk of developing complications from portal hypertension, including esophageal varices (EV). Baveno VI and expanded Baveno VI criteria, based on liver stiffness measurement (LSM) by transient elastography combined with platelet count, have been proposed to avoid unnecessary esophagogastroduodenoscopy (EGD) screening for large esophageal varices needing treatment (EVNT). This approach has not been validated in patients with chronic hepatitis B virus (HBV) infection, who have etiology-specific cut-off of LSM for liver fibrosis. Aims We aimed to validate the Baveno VI and expanded Baveno VI criteria for EVNT in HBV patients with cACLD. Methods We performed a retrospective analysis of HBV patients who underwent LSM in 2014–2020. Inclusion criteria were: a) diagnosis of cACLD, defined as LSM >9 kPa; b) availability of EGD and platelets within 1 year of LSM. Baveno VI (LSM <20 kPa and platelets >150,000) and expanded Baveno VI criteria (LSM <25 kPa and platelets >110,000) were tested for EGD sparing. Diagnostic performance of these criteria against gold standard (EGD) was computed and compared to patients with hepatitis C virus (HCV) infection and nonalcoholic steatohepatitis (NASH) etiologies, where these criteria have been widely validated. In these patients, the threshold for cACLD definition was >10 kPa. Results A total of 287 patients (mean age 56, 95% Child A) were included, comprising of 43 HBV (58% on antiviral therapy), 134 HCV and 110 NASH patients. The prevalence of any grade EV and EVNT was 25% and 8% in the whole cohort, with 19% and 5% in HBV patients, respectively. Table 1 reports diagnostic performance, spared EGD and missed EVNT according to non-invasive criteria and cACLD etiology. Both Baveno VI and expanded Baveno VI criteria performed well in patients with HBV-related cACLD. There was no significant difference on diagnostic performance of these non-invasive criteria across the cACLD etiologies. Conclusions These results support use of non-invasive criteria based on LSM and platelets to spare unnecessary EGD in patients with HBV and cACLD. Baveno VI and expanded Baveno VI criteria can improve resource utilization and avoid invasive testing in context of screening EGD for patients with HBV-related cACLD. Funding Agencies None

scholarly journals Non-Invasive Predictors of Esophageal Varices in Alcoholic Chronic Liver Disease

2019 ◽  
Vol 8 (2) ◽  
pp. 15-20
Author(s):  
Rishab Shrestha ◽  
Alisha Rajbhandari ◽  
Pradip Chaudhary ◽  
Kausal Sigdel
Keyword(s):  
Platelet Count ◽  
Liver Disease ◽  
Chronic Liver Disease ◽  
Alcoholic Liver Disease ◽  
Esophageal Varices ◽  
College Teaching ◽  
Diameter Ratio ◽  
Chronic Liver ◽  
Ethanol Ingestion ◽  
Non Invasive

Background: Alcohol is widely consumed socially accepted recreational beverage, that is toxic and affects directly or indirectly almost every organ. Spectrum of alcoholic liver disease ranges from fatty liver to cirrhosis. One of the complications of the later spectrum is portal hypertension, around 50% develops varices and bleeding depends on the size of the varices. Predicting varices without endoscopic is difficult but few non-invasive parameters are available. Materials and Methods: It was a prospective cross-sectional study done in Nobel Medical College Teaching Hospital, Biratnagar, Nepal from September 2018 to August 2019. Approval was acquired from Institutional Review Committee. Patients with chronic ethanol ingestion and features suggestive of chronic liver disease clinically and investigation wise were enrolled in the study. History, physical examinations along with platelet count, prothrombin time was taken and ultrasonography abdomen and upper gastrointestinal endoscopy was done to see the splenic diameter, and varices. Results: Esophageal varices were present in 53%. Mean platelet count with variceswas 122566 ± 36024.8 /mm3, splenic diameter was 133.1 ± 21.3 mm, prothrombintime (PT) time was 19.3 ± 5.0 sec andratio of platelet per spleen diameter was 930.2 ± 259.4 /mm3/mm.Platelet count < 163500/mm3 has sensitivity and specificity 83.0% and 83.0% respectively. Ratio of platelet per splenic diameter ratio cutoff 1293.7 has 88.7% sensitivity and 85.1% specificity for predicting varices. Conclusion: In chronic alcoholic liver disease patients low platelet count, increased splenicdiameter, low platelet per splenic diameter ratio are useful in predicting presence of esophageal varices.

scholarly journals Correlation Between Spleen Size, Thrombocytopenia and Meld Score in Chronic Liver Disease and Their Relation with Hospital Readmission

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5567-5567 ◽  
Author(s):  
Mashrafi Ahmed ◽  
Fawwad Zaidi ◽  
Tahmina Begum ◽  
Ashok R. Patel
Keyword(s):  
Chronic Hepatitis ◽  
Platelet Count ◽  
Liver Disease ◽  
Hepatitis B ◽  
Chronic Liver Disease ◽  
Univariate Analysis ◽  
Meld Score ◽  
Chronic Liver ◽  
Spleen Size ◽  
Platelet Growth Factor

Abstract Introduction: Cirrhosis of liver due to chronic hepatitis B and/or C is a significant health care burden globally. Thrombocytopenia is one of the significant co-morbid conditions associated with cirrhosis. Splenomegaly had been pointed as one of the main factors behind thrombocytopenia in multiple studies. Another important aspect of this clinical condition is its high economic impact in the national health care budget. In this study, we re-evaluated the relation between thrombocytopenia, MELD score and spleen size in liver cirrhosis associated with chronic hepatitis B and/or C. We also evaluated the impact of these 3 factors over readmission of the patients at 30 and 90 days. Method: In this retrospective study, the medical records of patients admitted to Saint Joseph Hospital, Chicago, IL between January 1st, 2005 and December 31st, 2010 were queried for a discharge diagnosis of Chronic liver disease due to Hepatitis B and/or C. Result: Data Summary To examine the relationship between the biomarkers, scatter plot was generated for visual inspection. There was no apparent relationship between platelet count and MELD or spleen size. Correlation analysis by Spearman method showed a weak negative correlation between platelet count and MELD score (P=0.0051, coefficient = -0.26). To predict the probability of re-admission by the biomarkers, logistic regression was used to select significant predictors. From univariate analysis, only MELD was a significant predictor in 30-day re-admission (P=0.012, AUC=0.665). For 90-day re-admission, both MELD (P=0.0034, AUC=0.691) and platelet count (P=0.030, AUC=0.647) were significant predictors in univariate analysis. Summary In this study, all subjects have chronic liver disease due to viral infection. Platelet count is not related to MELD score or spleen size in these hepatitis B, C, or B/C patients. The combination of MELD, platelet count, and spleen size fairly predicts 30-day re-admission occurrence with an AUC of 0.726. Discussion: Thrombocytopenia is a common hematological complication in patient with chronic liver disease. The mechanism of thrombocytopenia classically is thought to be caused by pooling and destruction of platelets within the enlarged spleen. Other proposed mechanisms are impaired platelet production in the bone marrow, production of inhibitors of platelet production in the spleen, and decreased platelet growth factor thrombopoietin production from liver as well as increased degradation of thrombopoietin by platelets sequestered in the congested spleen. A recent study showed that in more severe chronic hepatitis due to hepatitis-c virus where severity was assessed with Child-Pugh score, both mature and premature platelet counts are low and this inverse relation also correlates with platelet growth factor thrombopoietin level which is low in more severe liver disease. Since Child-Pugh scoring system has some degree of limitation due to subjective variation, we decided to use MELD score for our patients to assess the severity of the chronic liver disease. Our study interestingly showed no correlation between platelet count, MELD score and spleen size. Study revealed only MELD was a significant predictor in 30-day re-admission (P=0.012, AUC=0.665). For 90-day re-admission, both MELD (P=0.0034, AUC=0.691) and platelet count (P=0.030, AUC=0.647) No correlation was observed even when cohorts were broken down into separately for male and female, for patients below and above 62 years old (the median age), and for each hepatitis subtype. 30-day re admission was clearly not related Platelet count or spleen alone but in combination they were linearly related to 30 and 90 day readmission. This study was important for multiple reasons. Firstly, 30 day readmission was calculated to be 16% and 90 day readmission was found to be 29% including the 16% from 30-day readmission. Surprisingly MELD alone was not a good predictor for 30 day readmission, but in combination with other parameters Spleen size and platelet count, predictions were fairly accurate. Table 1. Statistical Analysis and Results Table 1. Statistical Analysis and Results Figure 1. ROC of 30-day re-admission. Figure 1. ROC of 30-day re-admission. Figure 2. ROC of 90-day re-admission. Figure 2. ROC of 90-day re-admission. Disclosures No relevant conflicts of interest to declare.

scholarly journals Diagnostic accuracy of Platelet Count for prediction of Esophageal varices in patients presenting with Chronic Liver disease.

2020 ◽  
Vol 27 (01) ◽  
pp. 16-22
Author(s):  
Siraj ud Din Barech ◽  
Tahir Ullah Khan ◽  
Muhammad Niaz Khan
Keyword(s):  
Platelet Count ◽  
Liver Disease ◽  
Diagnostic Accuracy ◽  
Chronic Liver Disease ◽  
Esophageal Varices ◽  
Invasive Procedure ◽  
Cross Sectional Study ◽  
Chronic Liver ◽  
Cross Sectional ◽  
Low Platelet Count

Thrombocytopenia increases the risk of bleeding in CLD patients. The determination of the presence of Esophageal Varices (EV) by endoscopy is an invasive procedure. As a noninvasive tool, low platelet count (PC) can be helpful in prediction of variceal bleed in CLD patients with esophageal varices. Objectives: To assess the diagnostic accuracy of thrombocytopenia in predicting the presence of esophageal varices in patients with chronic liver disease. Study Design: Descriptive Cross sectional study. Setting: Medicine Unit I, Sheikh Zayed Hospital, Lahore. Period: 6 months from 1-07-2015 to 31-12-2015. Material and Methods: About 150 cases were included in our study through Non-Probability, Consecutive sampling method after obtaining written Informed consent. Blood sample was obtained from each patient and were immediately sent to the laboratory for assessment of platelet count. Reports were assessed. Those with low platelet count were referred to endoscopy room for confirmation of esophageal varices. Reports of endoscopy were compared with platelet count. Data was entered and analyzed through SPSS version 23. Results: Mean age of patients was 49.64±11.54 years. There were 97(64.7%) male and 53(35.3%) female patients. Mean duration of chronic liver disease of patients was 3.51±1.39. Mean platelet count of patients was 172.3±81.20. Sensitivity and Specificity of Thrombocytopenia for prediction of esophageal varices in patients presenting with chronic liver disease was 92.63% and 89.09%. While PPV, NPV and Diagnostic accuracy of Thrombocytopenia for prediction of esophageal varices was 93.62%, 87.5% and 91.33% respectively. Conclusion: It has been concluded from the present study that PC has high accuracy for detection of EVs and can be helpful in prediction of EVs in CLD patients.

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