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Xuan J, Shi Z. Shear wave elastography measured liver stiffness-spleen size-to-platelet ratio for the prediction of high-risk oesophageal varices: a meta-analysis. Eur J Gastroenterol Hepatol 2023; 35:753-760. [PMID: 37115975 DOI: 10.1097/meg.0000000000002542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
OBJECTIVES The potential predictive role of shear wave elastography (SWE) measured liver stiffness-spleen size-to-platelet ratio score (LSPS) for high-risk oesophageal varices (HREV) in patients with cirrhosis remains controversial. A systematic review and meta-analysis was performed to investigate the diagnostic efficacy of SWE-measured LSPS for HREV. METHODS Relevant studies were retrieved by searching PubMed, Embase, Web of Science, Wanfang, and CNKI databases. Only studies comparing the diagnostic efficacy of SWE-measured LSPS with oesophagogastroduodenoscopy for HREV in patients with cirrhosis were included. Pooled sensitivity and specificity were calculated with a random-effect model. RESULTS Overall, eight cohorts were included. Four of them used point SWE (pSWE) and the other four used 2D-SWE. Pooled results showed that a high LSPS measured by pSWE and 2D-SWE were both associated with satisfying diagnostic efficacy for endoscopic-evidenced HREV, with pooled sensitivity, specificity, diagnostic odds ratio, and pooled area under receiver operating characteristic curve of 0.86, 0.86, 39.36, and 0.92 for pSWE-derived LSPS, and 0.77, 0.86, 20.64, and 0.89 for 2D-SWE-derived LSPS. No significant difference was observed in the diagnostic efficacy between pSWE- and 2D-SWE-derived LSPS ( P all > 0.05). Significant heterogeneity was observed. However, further subgroup and meta-regression analysis failed to show that differences in study design, sex, diagnosis (compensated or overall cirrhosis), or LPSP cutoffs may lead to heterogeneity ( P for subgroup difference > 0.05). CONCLUSION A high LSPS with liver stiffness measured by pSWE or 2D-SWE shows satisfying predictive accuracy for HREV in patients with cirrhosis.
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Affiliation(s)
| | - Zhewei Shi
- Department of Cardiology, Zhuji Affiliated Hospital of Wenzhou Medical University, Zhuji, China
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Nomogram model for predicting esophsagogastric varices in hepatocellular carcinoma with cirrhosis. Eur J Gastroenterol Hepatol 2023; 35:342-348. [PMID: 36708306 DOI: 10.1097/meg.0000000000002496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND/AIMS The prognosis for hepatocellular carcinoma (HCC) with cirrhosis is poor. The risk of death also increases in patients with esophagogastric varices (EGV). Based on routine clinical features and related noninvasive parameters, a nomogram prediction model was developed in this study to facilitate the early identification of EGV in HCC patients. METHODS A retrospective cohort analysis of patients with HCC in the Renmin Hospital of Wuhan University from 2020 to 2021 was performed. Clinical and noninvasive parameters closely related to EGV risk were screened by univariate and multivariate logistic regression analysis and integrated into a nomogram. The nomogram was validated internally and externally by calibration, receiver operating characteristic curve and decision curve analysis (DCA). RESULTS A total of 165 patients with HCC-related cirrhosis were recruited. In the raining cohort, multivariate logistic regression analysis identified platelet (PLT) [odds ratio (OR), 0.950; 95% confidence interval (CI), 0.925-0.977; P < 0.001], D-dimer (OR. 3.341; 95% CI, 1.751-6.376, P < 0.001), spleen diameter (SD) (OR, 2.585; 95% CI, 1.547-4.318; P < 0.001) as independent indicators for EGV. The nomogram for predicting EGV risk was well calibrated with a favorable discriminative ability and an area under curve of 0.961. In addition, the nomogram showed better net benefits in the DCA. The results were validated in the validation cohort. CONCLUSIONS The proposed nomogram model based on three indicators (PLT, D-dimer and SD) showed an excellent predictive effect, leading to the avoidance of unnecessary esophagogastroduodenoscopy.
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Liang XE, Hu XM, Wang HY, Dai L, Lin XY, Chen JJ, Chen YP, Wen B, Jiang RL. Ultrasonic spleen thickness-based indexes surpass Baveno VI criteria in high-risk gastroesophageal varices detection. Hepatol Int 2022; 16:649-657. [PMID: 35412215 DOI: 10.1007/s12072-022-10327-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/03/2022] [Indexed: 11/26/2022]
Abstract
AIMS To evaluate the efficiency of ultrasonic spleen thickness (UST), routine variables and (expanded) Baveno VI criteria for high-risk gastroesophageal varices (HRGOV) detection in cirrhotic patients. METHODS In total, 305 cirrhotic patients were retrospectively enrolled in the deriving cohort and 328 cirrhotic patients with hepatitis B sustained viral response were prospectively enrolled in the validation cohort. HRGOV was defined as medium and severe gastroesophageal varices (GOV), mild GOV with red signs or Child-Pugh C. The cut-offs for HRGOV were determined by likelihood ratio indicating strong evidences. Algorithms of Spleen thickness-Age-Liver stiffness measurement (LSM, by Fibroscan®)-Albumin (SALA) and Spleen thickness-Platelet-Albumin (SPA) were derived by multivariate analyses. RESULTS The area under receiver operating characteristics curve of SALA, SPA, UST, platelet, and LSM were 0.849, 0.835, 0.808, 0.746, and 0.655 in the deriving cohort, and improved to 0.901, 0.904, 0.858, 0.876, and 0.811 in the validation cohort, respectively. While SALA, SPA, UST, platelet, Baveno VI criteria (BVI), and expanded BVI spared 46.6%, 38.0%, 29.2%, 21.0%, 12.1%, and 23.6% esophagogastroduodenoscopy in the deriving cohort, these numbers were improved to 68.1%, 66.8%, 27.1%, 37.8%, 36.0%, and 61.0% in the validating cohort, respectively; however, the negative likelihood ratio of expanded BVI was up to 0.16. SPA spared less esophagogastroduodenoscopy than SALA, which can be supplemented by stepwise applying UST and SPA. Sequentially combining UST and SALA, BVI and SALA exempted additional 10-5% endoscopies. CONCLUSIONS SPA, without LSM, improves HRGOV detection comparing with BVI. UST based algorithms combination can achieve the best efficiency especially in sustained virus response hepatitis B.
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Affiliation(s)
- Xie-Er Liang
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou North Avenue, Guangzhou, 510515, Guangdong, China
| | - Xiao-Min Hu
- Hepatology Unit, Shenzhen Hospital, Southern Medical University, No. 1333 Xinhu Road, Shenzhen, 518110, Guangdong, China
| | - Hai-Yu Wang
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou North Avenue, Guangzhou, 510515, Guangdong, China
| | - Lin Dai
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou North Avenue, Guangzhou, 510515, Guangdong, China
| | - Xiao-Yu Lin
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou North Avenue, Guangzhou, 510515, Guangdong, China
| | - Jin-Jun Chen
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou North Avenue, Guangzhou, 510515, Guangdong, China
| | - Yong-Peng Chen
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou North Avenue, Guangzhou, 510515, Guangdong, China.
- Hepatology Unit, Shenzhen Hospital, Southern Medical University, No. 1333 Xinhu Road, Shenzhen, 518110, Guangdong, China.
| | - Biao Wen
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou North Avenue, Guangzhou, 510515, Guangdong, China.
- Department of Gastroenterology, The First Affiliated Hospital of Chengdu Medical College, No. 278 Baoguang Road, Chengdu, 610000, Sichuan, China.
| | - Rong-Long Jiang
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou North Avenue, Guangzhou, 510515, Guangdong, China.
- Hepatology Unit, Shenzhen Hospital, Southern Medical University, No. 1333 Xinhu Road, Shenzhen, 518110, Guangdong, China.
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Tanaka K, Tsuji K, Matsui T, Kang JH, Sakurai Y, Kodama Y, Minami R, Watanabe K, Katanuma A. Potential of PALBI-T score as a prognostic model for hepatocellular carcinoma in alcoholic liver disease. JGH Open 2022; 6:36-43. [PMID: 35071786 PMCID: PMC8762626 DOI: 10.1002/jgh3.12705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 12/13/2021] [Accepted: 12/25/2021] [Indexed: 11/20/2022]
Abstract
Background and Aim With the control of viral hepatitis, alcoholic hepatocellular carcinoma (HCC) is becoming increasingly important in Japan. In alcoholic cirrhosis, the impact of portal hypertension is significant. Thus, it may be difficult to predict prognosis accurately with the reported prognostic scores. Here we propose the platelet‐albumin‐bilirubin tumor nodes metastasis (TNM) score (PALBI‐T score) as a prognostic model for HCC in alcoholic liver disease, and investigate its usefulness. The PALBI‐T score is an integrated score based on the TNM stage and PALBI grade including platelets, reflecting portal hypertension. Methods This study included 163 patients with alcoholic HCC treated at our Center from 1997 to 2018. We compared the prognostic prediction abilities of the Japan Integrated Staging (JIS) score, ALBI‐T score, and PALBI‐T score. The PALBI‐T score was calculated similarly to the JIS and ALBI‐T scores. Areas under the receiver operating characteristic curve (AUC) were calculated for predicting overall survival (OS). Results In predicting the 1‐year survival, the JIS score had a larger AUC (AUC = 0.925) than the ALBI‐T score (AUC = 0.895) and PALBI‐T score (AUC = 0.891). On the other hand, there was no significant difference in predicting OS among the integrated scores. The PALBI‐T score (AUC = 0.740) had the largest AUC, and the JIS score (AUC = 0.729) and ALBI‐T score (AUC = 0.717) were not significantly different from the PALBI grade (AUC = 0.634). The PALBI grade reflected the degree of portal hypertension. Conclusion In patients with alcoholic HCC, the Japan Integrated Staging score is useful for predicting short‐term prognosis. The PALBI‐T score, which reflects portal hypertension, appears to be a more valid prognostic score for predicting long‐term prognosis.
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Affiliation(s)
- Kazunari Tanaka
- Center for Gastroenterology Teine Keijinkai Hospital Sapporo Japan
| | - Kunihiko Tsuji
- Center for Gastroenterology Teine Keijinkai Hospital Sapporo Japan
| | - Takeshi Matsui
- Center for Gastroenterology Teine Keijinkai Hospital Sapporo Japan
| | - Jong-Hon Kang
- Center for Gastroenterology Teine Keijinkai Hospital Sapporo Japan
| | - Yasuo Sakurai
- Center for Gastroenterology Teine Keijinkai Hospital Sapporo Japan
| | - Yoshihisa Kodama
- Center for Gastroenterology Teine Keijinkai Hospital Sapporo Japan
| | - Ryosuke Minami
- Center for Gastroenterology Teine Keijinkai Hospital Sapporo Japan
| | - Kiichi Watanabe
- Center for Gastroenterology Teine Keijinkai Hospital Sapporo Japan
| | - Akio Katanuma
- Center for Gastroenterology Teine Keijinkai Hospital Sapporo Japan
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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 2021; 16:e0260774. [PMID: 34855845 PMCID: PMC8638864 DOI: 10.1371/journal.pone.0260774] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 11/16/2021] [Indexed: 12/17/2022] Open
Abstract
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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Hashim A, Berzigotti A. Noninvasive Assessment of Schistosoma-Related Periportal Fibrosis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:2273-2287. [PMID: 33448437 DOI: 10.1002/jum.15623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 06/12/2023]
Abstract
Schistosomiasis affects nearly 250 million individuals in the world. Hepatosplenic schistosomiasis (HSS) results in periportal fibrosis (PPF) and portal hypertension (pHTN). Ultrasound has been extensively used for the diagnosis of Schistosoma-related PPF and a number of staging methods have been validated for this purpose such as Strickland classification and Niamey protocol. Nevertheless, the application of noninvasive techniques, particularly elastography modalities, has not been well explored. In this review, we describe the various noninvasive diagnostic tools for assessment of Schistosoma-related PPF including US parameters, serum biomarkers, and US-based elastography techniques. While elastography techniques have demonstrated value in the evaluation of HSS, the evidence remains limited with most studies recruiting a small number of patients. Longitudinal studies with larger sample size are required in order to devise robust criteria to accurately assess the performance of noninvasive techniques in the prediction of both regression and progression of the degree of PPF and identify their cost-effectiveness in community screening.
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Affiliation(s)
- Ahmed Hashim
- Hepatology Department, Royal Free Hospital, London, UK
| | - Annalisa Berzigotti
- University of Clinic for Visceral Surgery and Medicine, Inselspital, University of Bern, Bern, Switzerland
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Gunda DW, Mtui EF, Manyiri PM, Majinge DC, Kilonzo SB, Mazigo HD, Kidenya BR. Schistosoma mansoni-related periportal fibrosis; can we use APRI and PSDR levels in the real-time selection of patients for targeted endoscopy in a resource-limited setting? A case-control study. BMC Gastroenterol 2021; 21:219. [PMID: 33985430 PMCID: PMC8117578 DOI: 10.1186/s12876-021-01802-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/03/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Schistosoma mansoni related hepatic fibrosis is usually associated with hemodynamic alteration with increased mortality due to bleeding varices. The diagnosis of varices before bleeding imposes a big challenge in resource-limited countries using endoscopy. Published evidence on the utility of non-invasive clinical tools in predicting the presence of varices among patients with S. mansoni related periportal fibrosis is still inadequate including Aspartate to platelet ratio index (APRI) and Platelet to splenic diameter ratio (PSDR) levels. This study describes the determinants of portal varices and assesses the potential utility of the APRI and PSDR level in the discrimination of portal varices among patients with S. mansoni related periportal fibrosis (PPF). METHODS A case-control study using cross-sectional data was done among patients with Schistosoma mansoni related periportal fibrosis at Bugando Medical Centre, in Mwanza Tanzania. The derivation cohort included patients enrolled between 2015 and 2019 and the validation cohort included patients enrolled from 2019 till March 2021. Socio-demographic, laboratory, ultrasound, and upper digestive endoscopic information were analyzed using STATA 13. The prevalence and determinants of varices were determined by logistic regression. The sensitivity and specificity of independent factors were determined to assess their utility in discriminating the presence of portal varices in patients with PPF. RESULTS In total, 250 patients were included in the derivation cohort, 109 (43.6%; 95% CI 37.3-49.9) of them had varices. The odds of having varices were independently increased among patients with higher APRI levels than 1.51, (AOR: 5.8; 95% CI 3.1-11.1; p < 0.001) and PSDR levels that were lower than 5700 (AOR: 5.9; 95% CI 3.2-11.2; p < 0.001). Both APRI and PSDR levels had significantly high sensitivity and specificity in predicting the presence of esophageal varices. However, the combined values of APRI and PSDR had higher specificity than any of the two markers. Of the 200 patients in the validation cohort 94 (47.0%; 95% CI 40.0-54.2) had varices, the discriminative power of the final model and the predictive ability of both APRI, PSDR, and APRI-PSDR combined levels were highly maintained. CONCLUSIONS This study indicates that varices are a common encounter among patients with S. mansoni related periportal fibrosis and it is independently associated with higher APRI and lower PSDR levels suggesting that these tools are potential discriminators of varices in this subgroup of patients. The reproducibility of these results should further be assessed longitudinally as potential non-invasive tools in selecting patients at high risk of having esophageal varices who could benefit from the targeted endoscopic intervention in a resource-limited setting like ours.
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Affiliation(s)
- Daniel W. Gunda
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, 1464 Mwanza, Tanzania
- Department of Internal Medicine, Bugando Medical Centre, 1370 Mwanza, Tanzania
| | - Elizabeth F. Mtui
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, 1464 Mwanza, Tanzania
| | - Paulina M. Manyiri
- Department of Internal Medicine, Bugando Medical Centre, 1370 Mwanza, Tanzania
| | - David C. Majinge
- Department of Internal Medicine, Bugando Medical Centre, 1370 Mwanza, Tanzania
| | - Semvua B. Kilonzo
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, 1464 Mwanza, Tanzania
- Department of Internal Medicine, Bugando Medical Centre, 1370 Mwanza, Tanzania
| | - Humphrey D. Mazigo
- Department of Parasitology, Catholic University of Health and Allied Sciences, 1464 Mwanza, Tanzania
| | - Benson R. Kidenya
- Department of Biochemistry and Molecular Biology, Catholic University of Health and Allied Sciences, 1464 Mwanza, Tanzania
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Martínez-Marín JD, Marrugo-Padilla K, Garzón-Olarte MA. Diagnostic performance of platelet count/spleen diameter ratio to detect esophageal varices in patients with cirrhosis. REVISTA DE LA FACULTAD DE MEDICINA 2021. [DOI: 10.15446/revfacmed.v69n3.78786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: The platelet count/spleen diameter (PC/SD) ratio is a noninvasive method for the diagnosis of esophageal varices (EV) used as an alternative to endoscopy in patients with cirrhosis.
Objective: To evaluate the diagnostic performance of the PC/SD ratio (cut-off point <909) to detect EV in patients with cirrhosis treated at a tertiary referral hospital in Bogotá D.C., Colombia.
Materials and methods: A prospective diagnostic test accuracy study was conducted in 66 patients with cirrhosis treated at the Hospital Universitario de La Samaritana between July and December 2018. A descriptive analysis of the data was performed. In addition, the diagnostic performance of the PC/SD ratio (cut-off point <909) for the detection of EV was compared with the findings reported in the esophagogastroduodenoscopy (gold standard), calculating its sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR-). A significance level of p<0.05 was considered.
Results: The mean age of the participants was 65.5 years, 53.03% were female, and the most common causes of cirrhosis were alcohol consumption (40.90%) and autoimmune hepatitis (22.72%). EV was diagnosed in 48 patients (72.72%). The PC/SC ratio showed sensitivity of 60%, specificity of 78%, PPV of 0.88, NPV of 0.42, LR+ of 2.73, and LR- of 0.51.
Conclusion: The low sensitivity, specificity, and NPV found in the present study suggest that the PC/SD ratio (cut-off point <909) may not be a useful diagnostic test for detecting EV in patients with cirrhosis.
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Spleen Stiffness Probability Index (SSPI): A simple and accurate method to detect esophageal varices in patients with compensated liver cirrhosis. Ann Hepatol 2021; 19:53-61. [PMID: 31740162 DOI: 10.1016/j.aohep.2019.09.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/11/2019] [Accepted: 09/12/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES Recent findings pointed out that even low-risk esophageal varices (EVs) are markers of severe prognosis. Accordingly, we analyzed spleen stiffness (SS) as a non-invasive method to predict EVs of any grade in a cohort of patients with compensated liver cirrhosis. METHOD We measured SS and liver stiffness (LS) using point-Shear-Wave Elastography (pSWE) with Philips Affiniti 70 system in 210 cirrhotic patients who had undergone endoscopic screening for EVs. We compared SS and LS predictive capability for EVs of any grade. RESULTS SS was higher in cirrhotic patients with EVs if compared to patients without EVs (p<0.001). The cut-off analysis detected 31kPa (100% sensitivity and negative predictive value) as the value to rule-out EVs and 69kPa (100% specificity and positive predictive value) to rule-in EVs. Besides, we developed the Spleen Stiffness Probability Index (SSPI), that can provide a probability of presence/absence of EVs. SSPI was the best model according to all discriminative and calibration metrics (AIC=120, BIC=127, AUROC=0.95, Pseudo-R2=0.74). SS demonstrated higher correlation with spleen bipolar diameter and spleen surface (r=0.52/0.55) if compared to LS (r=0.30/0.25) - and with platelet count as well (r=0.67 vs r=0.4). CONCLUSION SS showed significantly higher performance than other parameters, proving to be the best non-invasive test in the screening of EVs: by directly applying SS cut-off of 31kPa, our department could have safely avoided endoscopy in 36% of patients. Despite cut-off analyses, it was possible to create a probability model that could further stratify low-risk from high-risk patients (for any grade of EVs).
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Giannini EG, De Maria C, Crespi M, Demarzo MG, Fazio V, Grasso A, Torre F, Bodini G, Marabotto E, Furnari M. Course of oesophageal varices and performance of noninvasive predictors following Hepatitis C Virus clearance in compensated advanced chronic liver disease. Eur J Clin Invest 2020; 50:e13231. [PMID: 32291753 DOI: 10.1111/eci.13231] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 02/25/2020] [Accepted: 03/19/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND In patients with hepatitis C virus (HCV) and compensated advanced chronic liver disease (cACLD), there is evidence that sustained virological response (SVR) to direct-acting antivirals (DAA) may ameliorate portal hypertension, although both the course of oesophageal varices and the performance of their noninvasive predictors following DAA-induced SVR are less defined. In this study, our aim was to assess the variation in oesophageal varices status in HCV patients with cACLD who obtained an SVR to DAAs and to evaluate the diagnostic performance of noninvasive predictors of varices after HCV cure. MATERIAL AND METHODS Sixty-three HCV patients with cACLD and SVR to DAAs were prospectively followed up, and oesophageal varices surveillance was carried out according to the Baveno VI indications. Appearance and disappearance of varices, accuracy performance of their noninvasive predictors (Baveno/expanded Baveno VI criteria, platelet count/spleen diameter ratio) and number of endoscopies spared with their application were calculated. RESULTS Following SVR, varices developed or disappeared in 12.1% and 17.4% of patients, respectively. The negative predictive value for varices of the Baveno VI, expanded Baveno VI criteria and platelet count/spleen diameter ratio following SVR was 88.2% (65.6-96.7), 83.3% (66.3-92.7) and 80.7% (67.1-89.5), respectively. Their application would have saved 30.4%, 42.9% and 55.4% of endoscopies, with no varices needing treatment missed using both Baveno VI criteria. CONCLUSIONS In HCV patients with cACLD, following SVR to DAA, the expanded Baveno VI criteria provide the best balance between utility (diagnostic accuracy and endoscopies avoided) and safety (varices needing treatment missed) for varices surveillance.
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Affiliation(s)
- Edoardo G Giannini
- Gastroenterology Unit, Department of Internal Medicine, IRCCS-Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Costanza De Maria
- Gastroenterology Unit, Department of Internal Medicine, IRCCS-Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Mattia Crespi
- Gastroenterology Unit, Department of Internal Medicine, IRCCS-Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Maria Giulia Demarzo
- Gastroenterology Unit, Department of Internal Medicine, IRCCS-Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Valentina Fazio
- Gastroenterology Unit, Department of Internal Medicine, San Paolo Hospital, Savona, Italy
| | - Alessandro Grasso
- Gastroenterology Unit, Department of Internal Medicine, San Paolo Hospital, Savona, Italy
| | - Francesco Torre
- Gastroenterology Unit, Department of Internal Medicine, IRCCS-Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Giorgia Bodini
- Gastroenterology Unit, Department of Internal Medicine, IRCCS-Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Elisa Marabotto
- Gastroenterology Unit, Department of Internal Medicine, IRCCS-Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Manuele Furnari
- Gastroenterology Unit, Department of Internal Medicine, IRCCS-Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
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Chen Y, Wang Y, Chen Y, Yu Z, Chi X, Hu KQ, Li Q, Tan L, Xiang D, Shang Q, Lei C, Chen L, Hu X, Wang J, Liu H, Lu W, Chi W, Dong Z, Wang X, Li Z, Xiao H, Chen D, Bai W, Zhang C, Xiao G, Qi X, Chen J, Zhou L, Sun H, Deng M, Qi X, Zhang Z, Qi X, Yang Y. A Novel Noninvasive Program for Staging Liver Fibrosis in Untreated Patients With Chronic Hepatitis B. Clin Transl Gastroenterol 2019; 10:1-12. [PMID: 31033506 PMCID: PMC6602766 DOI: 10.14309/ctg.0000000000000033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Chronic hepatitis B (CHB) can progress into liver fibrosis and cirrhosis with poor outcomes. Early and accurate diagnosis of liver fibrosis/cirrhosis is important to guide the preventive strategy of their related complications. METHODS A Chinese multicenter cross-sectional study was conducted to develop and validate a novel noninvasive program for staging liver fibrosis in untreated patients with CHB. Liver histology was evaluated independently by 2 pathologists. The alanine aminotransferase ratio, Hepascore, and aspartate aminotransferase to platelet index values were calculated. Liver stiffness measurement (LSM) and diameter of the spleen were measured. Logistic regression with ℓ1 penalty of regression coefficients was used to select the optimal predictors. The diagnostic accuracy for the stage of liver fibrosis was assessed by the area under the receiver operator characteristic curve with 95% confidence interval (CI). RESULTS A total of 1,200 patients with CHB were included, of whom 800 and 400 were in training and validation sets, respectively. LSM, platelets, age, hyaluronic acid, and diameter of the spleen were the top 5 predictors associated with any stage of liver fibrosis and integrated into a novel noninvasive program, named as the Chin-CHB score. The area under the receiver operator characteristic curve of the Chin-CHB score was 0.893 (95% CI: 0.77-0.92) for diagnosing significant fibrosis, 0.897 (95% CI: 0.85-0.95) for advanced fibrosis, and 0.909 (95% CI: 0.87-0.95) for cirrhosis. The diagnostic performance of the Chin-CHB score was similar between training and validation sets. The Chin-CHB score had better diagnostic performance than aspartate aminotransferase to platelet index, alanine aminotransferase ratio, LSM alone, and Hepascore for diagnosing any stage of liver fibrosis. CONCLUSIONS The Chin-CHB score had good diagnostic performance for any stage of liver fibrosis.
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Affiliation(s)
- Yan Chen
- Center of Therapeutic Research for Liver Cancer, Beijing 302 Hospital, Beijing, China
| | - Yongji Wang
- Department of Health Statistics, the Fourth Military Medical University, Xi'an, Shanxi Province, China
| | - Yongping Chen
- Department of Infectious and Liver Diseases, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Zujiang Yu
- Department of Infectious Disease, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Xiaoling Chi
- Traditional Chinese Medicine Hospital of Guangdong Province, Guangdong Province, China
| | - Ke-Qin Hu
- Division of Gastroenterology and Hepatology, University of California, Irvine, School of Medicine, Orange, California, USA
| | - Qin Li
- Fuzhou Infectious Diseases Hospital, Fuzhou, Fujian Province, China
| | - Lin Tan
- Liver Disease Department, Fuyang 2nd People's Hospital, Fuyang, Anhui Province, China
| | - Dedong Xiang
- Department of Infectious Diseases, Southwest Hospital, the Third Military Medical University, Chongqing, China
| | - Qinghua Shang
- Therapeutic Center for Liver Disease, the 88th Hospital of PLA, Taian, Shandong Province, China
| | - Chunliang Lei
- Guangzhou 8th People's Hospital, Guangzhou, Guangdong Province, China
| | - Liang Chen
- Department of Hepatic Diseases, Shanghai Public Health Clinical Center, Shanghai, China
| | - Xiaoyu Hu
- National Integrative Medicine Clinical Base for Infectious Diseases/Department of Infectious Diseases, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Jing Wang
- Affiliated Traditional Chinese Medicine Hospital of Luzhou Medical University, Luzhou, Sichuan Province, China
| | - Huabao Liu
- Traditional Chinese Medicine Hospital of Chongqing, Chongqing, China
| | - Wei Lu
- Tianjin Second People's Hospital, Tianjin Institute of Hepatology, Tianjin, China
| | - Weilai Chi
- Center for Quantitative Biology, Peking University, Beijing, China
| | - Zheng Dong
- Center of Therapeutic Research for Liver Cancer, Beijing 302 Hospital, Beijing, China
| | - Xiaodong Wang
- Department of Infectious and Liver Diseases, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Zhiqin Li
- Department of Infectious Disease, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Huanming Xiao
- Traditional Chinese Medicine Hospital of Guangdong Province, Guangdong Province, China
| | - Da Chen
- Division of Gastroenterology and Hepatology, University of California, Irvine, School of Medicine, Orange, California, USA
| | - Wenlin Bai
- Center of Therapeutic Research for Liver Cancer, Beijing 302 Hospital, Beijing, China
| | - Changjiang Zhang
- Department of Infectious Diseases, Southwest Hospital, the Third Military Medical University, Chongqing, China
| | - Guangming Xiao
- Guangzhou 8th People's Hospital, Guangzhou, Guangdong Province, China
| | - Xun Qi
- Department of Hepatic Diseases, Shanghai Public Health Clinical Center, Shanghai, China
| | - Jing Chen
- National Integrative Medicine Clinical Base for Infectious Diseases/Department of Infectious Diseases, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Li Zhou
- Traditional Chinese Medicine Hospital of Chongqing, Chongqing, China
| | - Huiwei Sun
- Center of Therapeutic Research for Liver Cancer, Beijing 302 Hospital, Beijing, China
| | - Minghua Deng
- Center for Quantitative Biology, Peking University, Beijing, China
| | - Xiaolong Qi
- CHESS, The Fifth Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China
| | - Zheng Zhang
- Center of Therapeutic Research for Liver Cancer, Beijing 302 Hospital, Beijing, China
| | - Xingshun Qi
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, Liaoning Province, China
| | - Yongping Yang
- Center of Therapeutic Research for Liver Cancer, Beijing 302 Hospital, Beijing, China
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Can acoustic radiation force imaging of the liver and spleen predict the presence of gastroesophageal varices? Clin Radiol 2018; 73:1046-1051. [PMID: 30245070 DOI: 10.1016/j.crad.2018.07.199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/19/2018] [Accepted: 07/19/2018] [Indexed: 12/15/2022]
Abstract
AIM To determine whether acoustic radiation force imaging (ARFI) of the liver/spleen could be used in patients with cirrhosis to predict the presence of gastroesophageal varices (GOVs). MATERIALS AND METHODS Fifty-eight patients with cirrhosis who were undergoing 6-monthly ultrasound examinations for hepatoma surveillance and who were due to have oesophagogastroduodenoscopy (OGD) within 6 months of their ultrasound were recruited. During routine ultrasound, the patient's liver and spleen were also assessed using ARFI. Other clinical parameters (platelet count, spleen size, and transient elastography measurements) were also collected. Logistic regression was used to determine which variables were significantly associated with presence or absence of varices univariably and multivariably RESULTS: Fourteen patients (24%) had GOVs. Patients with GOVs had higher ARFI measurements in the liver and spleen than patients without GOVs (liver: 2.39 versus 2.13, spleen: 2.89 versus 2.82), but these results were not statistically significant (odds ratio=1.75, 95% confidence interval [CI]=0.82, 3.91 and odds ratio=1.12, 95% CI=0.33, 3.97, respectively). The platelet/splenic ratio, in comparison, was associated with the presence or absence of GOVs in multivariate analysis (odds ratio=0.32, 95% CI=0.008, 0.91). CONCLUSION Although patients with GOVs had overall higher ARFI liver and spleen results, this was not statistically significant. As such, ARFI cannot yet replace OGD in predicting GOVs in this patient group.
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Tsaknakis B, Masri R, Amanzada A, Petzold G, Ellenrieder V, Neesse A, Kunsch S. Gall bladder wall thickening as non-invasive screening parameter for esophageal varices - a comparative endoscopic - sonographic study. BMC Gastroenterol 2018; 18:123. [PMID: 30071840 PMCID: PMC6090930 DOI: 10.1186/s12876-018-0852-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 07/25/2018] [Indexed: 12/20/2022] Open
Abstract
Background The mortality due to hemorrhage of esophageal varices (EV) is still high. The predominant cause for EV is liver cirrhosis, which has a high prevalence in Western Europe. Therefore, non-invasive screening markers for the presence of EV are of interest. Here, we aim to investigate whether non-inflammatory gall bladder wall thickening (GBWT) may serve as predictor for the presence of EV in comparison and combination with other non-invasive clinical and laboratory parameters. Methods One hundred ninety four patients were retrospectively enrolled in the study. Abdominal ultrasound, upper endoscopy and blood tests were evaluated. GBWT, spleen size and the presence of ascites were evaluated by ultrasound. Platelet count and Child-Pugh-score were also recorded. The study population was categorized in two groups: 122 patients without esophageal varices (non EV) compared to 72 patients with EV were analyzed by uni-and multivariate analysis. Results In the EV group 46% showed a non-inflammatory GBWT of ≥4 mm, compared to 12% in the non-EV group (p < 0.01). GBWT was significantly higher in EV patients compared to the non-EV group (mean: 4.4 mm vs. 2.8 mm, p < 0.0001), and multivariate analysis confirmed GBWT as independent predictor for EV (p < 0.04). The platelets/GBWT ratio (cut-off > 46.2) had a sensitivity and specificity of 78 and 86%, PPV 76% and NPV of 87%, and ROC analysis calculated the AUC of 0.864 (CI 0.809–0.919). Conclusions GBWT occurs significantly more often in patients with EV. However, because of the low sensitivity, combination with other non-invasive parameters such as platelet count is recommended.
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Affiliation(s)
- Birgit Tsaknakis
- Department Gastroenterology and Gastrointestinal Oncology, University Medical Centre Goettingen Georg-August-University, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Rawan Masri
- Department Gastroenterology and Gastrointestinal Oncology, University Medical Centre Goettingen Georg-August-University, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Ahmad Amanzada
- Department Gastroenterology and Gastrointestinal Oncology, University Medical Centre Goettingen Georg-August-University, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Golo Petzold
- Department Gastroenterology and Gastrointestinal Oncology, University Medical Centre Goettingen Georg-August-University, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Volker Ellenrieder
- Department Gastroenterology and Gastrointestinal Oncology, University Medical Centre Goettingen Georg-August-University, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Albrecht Neesse
- Department Gastroenterology and Gastrointestinal Oncology, University Medical Centre Goettingen Georg-August-University, Robert-Koch-Str. 40, 37075, Goettingen, Germany.
| | - Steffen Kunsch
- Department Gastroenterology and Gastrointestinal Oncology, University Medical Centre Goettingen Georg-August-University, Robert-Koch-Str. 40, 37075, Goettingen, Germany
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