Deciding Among Noninvasive Tools for Predicting Varices Needing Treatment in Chronic Liver Disease: An Analysis of Asian Cohort

• Published in: The American journal of gastroenterology Vol. 115; no. 10; pp. 1650 - 1656
• Main Authors: Sharma, Sanchit, Agarwal, Samagra, Gunjan, Deepak, Kaushal, Kanav, Anand, Abhinav, Saraya, Anoop
• Format: Journal Article
• Language: English
• Published: United States Wolters Kluwer 01.10.2020; Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
• Subjects: Adult; Asian Continental Ancestry Group; Blood platelets; Decision Support Techniques; Elasticity Imaging Techniques; End Stage Liver Disease; Endoscopy, Digestive System; Enzymes; Esophageal and Gastric Varices - diagnosis; Esophageal and Gastric Varices - etiology; Esophageal and Gastric Varices - therapy; Etiology; Female; Gastroenterology; Hepatitis; Hepatitis B, Chronic - complications; Hepatitis C, Chronic - complications; Humans; India; Laboratories; Liver - diagnostic imaging; Liver Cirrhosis - blood; Liver Cirrhosis - complications; Liver Cirrhosis - diagnostic imaging; Liver Cirrhosis - metabolism; Liver Cirrhosis, Alcoholic - blood; Liver Cirrhosis, Alcoholic - complications; Liver Cirrhosis, Alcoholic - diagnostic imaging; Liver Cirrhosis, Alcoholic - metabolism; Liver diseases; Male; Middle Aged; Non-alcoholic Fatty Liver Disease - complications; Patients; Platelet Count; Predictive Value of Tests; Retrospective Studies; Risk Assessment; Serum Albumin - metabolism; Severity of Illness Index; Young Adult; India
• ISSN: 0002-9270; 1572-0241
• DOI: 10.14309/ajg.0000000000000722

Both transient elastography (TE)-based and non-TE-based criteria exist for detection of varices needing treatment (VNT) in patients with asymptomatic advanced chronic liver disease (CLD). However, their performance in clinical settings at different risk thresholds of detection of VNT and in regions where elastography is not widely available is unknown. We aimed to validate existing noninvasive criteria in our patients with CLD and identify best TE- and non-TE-based criteria for VNT screening at usual risk thresholds. Patients with compensated advanced CLD (cACLD) who underwent esophagogastroduodenoscopy and TE within 3 months were included. Diagnostic performance of Baveno VI, expanded Baveno VI, platelet-model for end-stage liver disease, and platelet-albumin (Rete Sicilia Selezione Terapia-hepatitis C virus) criteria were estimated. Decision curve analysis was conducted for different predictors across range of threshold probabilities. A repeat analysis including all patients with compensated CLD (cACLD and non-cACLD) was performed to simulate absence of TE. A total of 1,657 patients (cACLD, 895; non-cACLD, 762) related to hepatitis B virus (38.2%), hepatitis C virus (33.4%), nonalcoholic steatohepatitis (14.7%), and alcohol (11.8%) were included. Baveno VI identified maximum VNT (97.3%) and had best negative predictive value (96.9%), followed by platelet-albumin criteria. Expanded Baveno VI and platelet-model for end-stage liver disease had intermediate performance. At threshold probability of 5%, Baveno VI criteria showed maximum net benefit, and platelet-albumin criteria was next best, with need for 95 additional elastographies to detect 1 additional VNT. Similar results were obtained on including all patients with compensated CLD irrespective of TE. Baveno VI criteria maximizes VNT yield at 5% threshold probability. An acceptable alternative is the platelet-albumin criteria in resource-limited settings.