Liver Transient Elastography Combined to Platelet Count (Baveno VI) Predict High Esophageal Varices in Black African Patient with Compensated Hepatitis B Related Cirrhosis

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

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Is transient elastography valuable for high-risk esophageal varices prediction in patients with hepatitis-B-related cirrhosis?

Journal of Gastroenterology and Hepatology ◽

10.1111/j.1440-1746.2011.06889.x ◽

2012 ◽

Vol 27 (3) ◽

pp. 533-539 ◽

Cited By ~ 19

Author(s):

Yong Peng Chen ◽

Qi Zhang ◽

Lin Dai ◽

Xie Er Liang ◽

Jie Peng ◽

...

Keyword(s):

High Risk ◽

Hepatitis B ◽

Esophageal Varices ◽

Transient Elastography

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Vibration-Controlled Transient Elastography (VCTE) Is Superior to Aspartate Aminotransferase-to-platelet Ratio Index (APRI) and Platelet Count for Identification of Esophageal Varices in Patients with Cirrhosis

The American Journal of Gastroenterology ◽

10.14309/00000434-201610001-00899 ◽

2016 ◽

Vol 111 ◽

pp. S392

Author(s):

Brett Rossow ◽

Marwan Ghabril ◽

Naga Chalasani ◽

Raj Vuppalanchi

Keyword(s):

Platelet Count ◽

Esophageal Varices ◽

Aspartate Aminotransferase ◽

Transient Elastography

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Comparison of Liver Biopsy and Transient Elastography based on Clinical Relevance

Canadian Journal of Gastroenterology ◽

10.1155/2008/306726 ◽

2008 ◽

Vol 22 (9) ◽

pp. 753-757 ◽

Cited By ~ 9

Author(s):

Ryota Masuzaki ◽

Ryosuke Tateishi ◽

Haruhiko Yoshida ◽

Eriko Goto ◽

Takahisa Sato ◽

...

Keyword(s):

Platelet Count ◽

Liver Biopsy ◽

Esophageal Varices ◽

Aspartate Aminotransferase ◽

Transient Elastography ◽

Fibrosis Stage ◽

Serum Total Bilirubin ◽

Albumin Concentration ◽

Prothrombin Activity ◽

Laboratory Test Results

BACKGROUND: Liver stiffness measurement (LSM) by transient elastography has recently been validated for the evaluation of liver fibrosis in chronic liver diseases. The present study focused on cases in which liver biopsy and LSM were discordant.METHODS: Three hundred eighty-six patients with chronic hepatitis C who underwent a liver biopsy between December 2004 and April 2007 were studied. First, the optimal cut-off value of LSM was selected for the determination of cirrhosis based on the receiver operating characteristic curve. Then, the cases in which liver histology and evaluation by LSM were discordant were selected. Laboratory test results such as serum total bilirubin concentration, prothrombin activity, albumin concentration, platelet count and the aspartate aminotransferase to platelet ratio index, together with the presence of esophageal varices, were analyzed.RESULTS: The optimal cut-off value was chosen to be 15.9 kPa for cirrhosis (fibrosis stage [F] 4) determination to maximize the sum of sensitivity (78.9%) and specificity (81.0%). There were 78 discordant cases: 51 patients showed an LSM of 15.9 kPa or higher and a fibrosis stage of F1 to F3 (high LSM group), and 27 patients had an LSM lower than 15.9 kPa and a fibrosis stage of F4 (low LSM group). Esophageal varices were seen in 11 patients in the high LSM group (n=51) and in no patients in the low LSM group (n=27) (P=0.0012). The aspartate aminotransferase to platelet ratio index was significantly higher in the high LSM group (1.49 versus 0.89, P=0.019). Other parameters did not differ significantly. However, platelet count, prothrombin activity and albumin concentration tended to be lower in the high LSM group.CONCLUSIONS: Patients with a high LSM need proper attention for cirrhosis, even if liver biopsy does not reveal cirrhosis.

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Platelet count/spleen volume ratio has a good predictive value for esophageal varices in patients with hepatitis B liver cirrhosis

PLoS ONE ◽

10.1371/journal.pone.0260774 ◽

2021 ◽

Vol 16 (12) ◽

pp. e0260774

Author(s):

Sihao Yu ◽

Wei Chen ◽

Zicheng Jiang

Keyword(s):

Platelet Count ◽

Magnetic Resonance ◽

Hepatitis B ◽

Esophageal Varices ◽

Multivariate Logistic Regression Analysis ◽

Volume Ratio ◽

Spleen Volume ◽

Magnetic Resonance Examination ◽

Research Subjects ◽

Clinical Value

Background & aims Platelet count/spleen longest diameter ratio (PSDR) is widely used in clinical practice due to its good performance in predicting esophageal varices (EV). We obtained spleen volume (SV) by magnetic resonance examination, the purpose of this study was to evaluate the clinical value of platelet count/spleen volume ratio (PSVR) and spleen volume in predicting EV in patients with hepatitis B cirrhosis. Methods: This study was a diagnostic accuracy experiment and retrospective, 199 patients with hepatitis B cirrhosis who met the criteria were selected as the research subjects. All patients were collected blood samples in the morning on an empty stomach within 2 days, and related indicators were tested. Within 10 days, they received electronic gastroscopy and abdominal magnetic resonance examination. According to the Child-Pugh score, the patients were divided into groups with or without EV and with or without high-risk esophageal varices (HRV), then statistical analysis of the two groups was performed. Results The area under the curve (AUC) of PSVR in predicting EV or HRV in each group (85.5%-92.6%) was higher than PSDR, SV, spleen diameter, and platelet count. The AUC of PSDR in diagnosing HRV was higher than SV, and the AUC of SV in diagnosing EV was higher than PSDR, but the difference was not significant (P>0.05). In Child-Pugh A patients, Multivariate logistic regression analysis showed PSVR could be a predictor of HRV (P<0.05), SV was a reliable predictor of EV (P<0.05). Conclusion PSVR is better than PSDR, spleen diameter, platelet count in predicting EV; in the absence of serological results, SV could be used instead of PSDR. Both can predict EV or HRV of patients with hepatitis B cirrhosis.

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