Spleen Stiffness-Based Algorithms Are Superior to Baveno VI Criteria to Rule Out Varices Needing Treatment in Patients With Advanced Chronic Liver Disease

被引:2
|
作者
Vanderschueren, Emma [1 ,2 ]
Armandi, Angelo [3 ,4 ]
Kwanten, Wilhelmus [5 ,6 ]
Cassiman, David [1 ,2 ]
Francque, Sven [5 ,6 ]
Schattenberg, Joern M. [7 ]
Laleman, Wim [1 ,2 ]
机构
[1] Univ Hosp Leuven, Dept Gastroenterol & Hepatol, Leuven, Belgium
[2] Katholieke Univ Leuven, Dept Chron Dis Metab & Aging CHROMETA, Leuven, Belgium
[3] Johannes Gutenberg Univ Mainz, Dept Internal Med 1, Metab Liver Dis Res Program, Univ Med Ctr, Mainz, Germany
[4] Univ Turin, Dept Med Sci, Div Gastroenterol & Hepatol, Turin, Italy
[5] Univ Antwerp UA, Lab Expt Med & Paediat LEMP, Antwerp, Belgium
[6] Univ Hosp Antwerp, Dept Gastroenterol & Hepatol, Antwerp, Belgium
[7] Saarland Univ, Dept Internal Med, Med Ctr, Homburg, Germany
来源
AMERICAN JOURNAL OF GASTROENTEROLOGY | 2024年 / 119卷 / 08期
关键词
elastography; spleen; portal hypertension; gastroesophageal varices; SIMPLE NONINVASIVE INDEX; LARGE ESOPHAGEAL-VARICES; PORTAL-HYPERTENSION; SIGNIFICANT FIBROSIS; CONSENSUS WORKSHOP; CIRRHOSIS; PREDICT; ELASTOGRAPHY; DIAGNOSIS; MODEL;
D O I
10.14309/ajg.0000000000002708
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
INTRODUCTION: The Baveno VI criteria have set the stage for noninvasive assessment of compensated advanced chronic liver disease (ACLD). The algorithm combining liver stiffness measurement (LSM, <20 kPa) and platelet count (>150,000/mu L) safely avoids screening endoscopy for varices needing treatment (VNT) but identifies only a relatively low number of patients. We aimed to evaluate the value of spleen stiffness measurement (SSM) using spleen-dedicated elastography in ruling out VNT. METHODS: In this real-life multicenter retrospective derivation-validation cohort, all consecutive patients with ACLD (defined by LSM >= 10 kPa) with available upper endoscopy, laboratory results, spleen diameter, LSM, and SSM measured with spleen-dedicated transient elastography were included. VNT were defined as medium-to-large varices or small varices with red spots. RESULTS: In the derivation cohort (n = 201, 11.9% VNT), SSM demonstrated excellent capability at identifying VNT (area under the receiver operating characteristic curve [AUROC] 0.88), outperforming LSM (AUROC 0.77, P = 0.03) and platelets (AUROC 0.73, P = 0.002). In comparison with Baveno VI criteria (33.8% spared endoscopies), the sequential Baveno VI plus SSM and a novel spleen size and stiffness model were able to increase the number of patients avoiding endoscopy (66.2% and 71.1%, respectively) without missing more than 5% of VNT. These findings were confirmed in an external validation cohort of patients with more advanced liver disease (n = 176, 34.7% VNT) in which the number of spared endoscopies tripled (27.3% and 31.3% for SSM-based algorithms) compared with Baveno VI criteria (8.5%). DISCUSSION: Spleen stiffness-based algorithms are superior to Baveno VI criteria in ruling out VNT in patients with ACLD and double the number of patients avoiding screening endoscopy.
引用
收藏
页码:1515 / 1524
页数:10
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