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Ravaioli F, Berger A, Farcau O, Colecchia A, Stefanescu H, Candillier C, Nahon P, Bureau C, Ganne-Carriè N, Berzigotti A, de Ledinghen V, Petta S, Calès P. Individual and population screening of varices needing treatment by a simple, safe and accurate test. Clin Res Hepatol Gastroenterol 2023; 47:102123. [PMID: 37061034 DOI: 10.1016/j.clinre.2023.102123] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 02/08/2023] [Accepted: 04/12/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND Several tests have been developed to screen VNT in different screening settings. We aimed to develop simple estimators to quantify VNT risk and spare endoscopy while missing <5% of VNT, adapted to different screenings in the main etiologies. METHODS 2,368 patients with chronic liver disease were included. The main VNT predictors were platelets, prothrombin index (PI) and LSM. Their interactions led to score construction, LIP: (LSM*45)/(PI*platelets), and BLIP: BMI-adjusted LIP in NAFLD. Scores were categorized either for population (VNT sensitivity ≥95%) or individual (negative predictive value ≥95%) VNT screening. RESULTS 1) Scores diagnosing VNT. AUROCs were, PLER: 0.767 Anticipate: 0.773 (p=0.059 vs previous), LIP: 0.779 (p=0.136), PLEASE: 0.789 (p=0.196). 2) Population screening performance was in increasing order (with missed VNT rate), Baveno6 criteria: 23.9% (2.5%), Anticipate 24.5%, p=0.367 vs previous (3.3%), PLER 27.3%, p<0.001 (3.6%), LIP 33.4%, p<0.001 (4.2%), PLEASE 35.2%, p=0.006 (3.6%). In NAFLD, LIP 38.6%, BLIP 40.8%, p=0.038. 3) Individual screening performance was, expanded Baveno6 criteria: 42.7%, LIP 54.1%, p<0.001. In NAFLD, performance was, NAFLD-cirrhosis criteria: 66.7%, BLIP 74.6%, p<0.001. CONCLUSION LIP combined simplicity, performance and safety in each etiology. In NAFLD, BMI-adjusted LIP outperformed other tests.
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Affiliation(s)
- Federico Ravaioli
- Gastroenterology and Hepatology Unit, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.
| | - Arthur Berger
- Hepato-Gastroenterology Department, University Hospital, Angers, France; HIFIH laboratory, UPRES 3859, UNIV Angers, France.
| | - Oana Farcau
- Liver Unit, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
| | - Antonio Colecchia
- Gastroenterology and Hepatology Unit, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy; Hepato-Gastroenterology Department, University Hospital, Angers, France; HIFIH laboratory, UPRES 3859, UNIV Angers, France; Liver Unit, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania; Department of Gastroenterology, University of Modena & Reggio Emilia and Azienda Ospedaliero-Universitaria di Modena, Italy.
| | - Horia Stefanescu
- Liver Unit, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
| | - Camille Candillier
- Hepato-Gastroenterology Department, University Hospital, Angers, France; HIFIH laboratory, UPRES 3859, UNIV Angers, France.
| | - Pierre Nahon
- Hepatology Department, Avicenne Hospital, Bobigny, Paris hospitals; INSERM UMR-1162, Paris Sorbonne University, France.
| | - Christophe Bureau
- Hepato-Gastroenterology Department, Purpan University Hospital, Toulouse, France.
| | - Nathalie Ganne-Carriè
- Hepatology Department, Avicenne Hospital, Bobigny, Paris hospitals; INSERM UMR-1162, Paris Sorbonne University, France.
| | - Annalisa Berzigotti
- Hepatology, Swiss Liver Center, Visceral Surgery and Medicine Clinic (UVCM), Inselspital, University of Bern, Switzerland.
| | | | - Salvatore Petta
- Department of Gastroenterology and Hepatology, PROMISE, University of Palermo, Palermo, Italy.
| | - Paul Calès
- Hepato-Gastroenterology Department, University Hospital, Angers, France; HIFIH laboratory, UPRES 3859, UNIV Angers, France.
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Calès P, Ravaioli F, Berger A, Farcau O, Festi D, Stefanescu H, Vitellius C, Nahon P, Bureau C, Ganne-Carriè N, Berzigotti A, de Ledinghen V, Petta S. Comparison of screening strategies with two new tests to score and diagnose varices needing treatment. Clin Res Hepatol Gastroenterol 2022; 46:101925. [PMID: 35470108 DOI: 10.1016/j.clinre.2022.101925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/08/2022] [Accepted: 04/15/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS We aimed to improve non-invasive screening of varices needing treatment (VNT) and compare different screening strategies. METHODS 2,290 patients with chronic liver disease were included in a retrospective study. Etiologies were: virus: 50.0%, NAFLD: 29.5%, alcohol: 20.5%, VNT: 14.9%. Test descriptors were performance (spared endoscopy) and safety (missed VNT). VNT tests were evaluated according to their safety levels either for individual screening (95% negative predictive value (NPV)), population screening (95% sensitivity) or undifferentiated screening (100% sensitivity/NPV) without missed VNT. The tests provided three categories: missed VNT <5%, VNT 100% specificity (new category), both sparing endoscopies, and intermediate (endoscopy required). RESULTS Independent VNT predictors (etiology, sex, age, platelets, prothrombin index, albumin, ALT, liver stiffness) were included in two tests: VNT virus alcohol NAFLD test (VANT) and varice risk score (VARS). We report results of the whole population. Considering population screening, performances were, Baveno VI criteria: 24.1%, Anticipate: 24.7%, VariScreen: 35.3%, VANT: 40.2% (p<0.001 vs other tests). VANT spared 58.0% more endoscopies in the whole population than Baveno criteria in compensated advanced chronic liver diseases. Considering individual screening, VARS performance was, in all patients: 62.0% vs 42.9% for the expanded Baveno VI criteria (p<0.001), and, in NAFLD: 72.8% vs 65.1% for the NAFLD cirrhosis criteria (p<0.001). Considering undifferentiated screening, VARS performance was 12%. The VARS score estimated VNT probability from 0 to 100% (AUROC: 0.826). CONCLUSION VANT and VARS spared from 12% (undifferentiated screening) to 40% (population screening) or 62% (individual screening) of endoscopies in main-etiology patients without ascites.
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Affiliation(s)
- Paul Calès
- Hepato-Gastroenterology Department, University Hospital, Angers, France; HIFIH laboratory, UPRES 3859, UNIV Angers, France.
| | - Federico Ravaioli
- Gastroenterology and Hepatology Unit, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.
| | - Arthur Berger
- Hepato-Gastroenterology Department, University Hospital, Angers, France; HIFIH laboratory, UPRES 3859, UNIV Angers, France.
| | - Oana Farcau
- Liver Unit, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Davide Festi
- Gastroenterology and Hepatology Unit, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.
| | - Horia Stefanescu
- Liver Unit, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
| | - Carole Vitellius
- Hepato-Gastroenterology Department, University Hospital, Angers, France; HIFIH laboratory, UPRES 3859, UNIV Angers, France.
| | - Pierre Nahon
- Hepatology Department, Avicenne Hospital, Bobigny, Paris hospitals, INSERM UMR-1162, Paris Sorbonne University, France.
| | - Christophe Bureau
- Hepato-Gastroenterology Department, Purpan University Hospital, Toulouse, France.
| | - Nathalie Ganne-Carriè
- Hepatology Department, Avicenne Hospital, Bobigny, Paris hospitals, INSERM UMR-1162, Paris Sorbonne University, France.
| | - Annalisa Berzigotti
- Hepatology, Swiss Liver Center, Visceral Surgery and Medicine Clinic (UVCM), Inselspital, University of Bern, Switzerland.
| | | | - Salvatore Petta
- Department of Gastroenterology and Hepatology, PROMISE, University of Palermo, Palermo, Italy.
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Berger A, Ravaioli F, Farcau O, Festi D, Stefanescu H, Buisson F, Nahon P, Bureau C, Ganne-Carriè N, Berzigotti A, de Ledinghen V, Petta S, Calès P. Including Ratio of Platelets to Liver Stiffness Improves Accuracy of Screening for Esophageal Varices That Require Treatment. Clin Gastroenterol Hepatol 2021; 19:777-787.e17. [PMID: 32562889 DOI: 10.1016/j.cgh.2020.06.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 06/02/2020] [Accepted: 06/11/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND & AIMS Based on platelets and liver stiffness measurements, the Baveno VI criteria (B6C), the expanded B6C (EB6C), and the ANTICIPATE score can be used to rule out varices needing treatment (VNT) in patients with compensated chronic liver disease. We aimed to improve these tests by including data on the ratio of platelets to liver stiffness. METHODS In a retrospective analysis of data from 10 study populations, collected from 2004 through 2018, we randomly assigned data from 2368 patients with chronic liver disease of different etiologies to a derivation population (n = 1579; 15.1% with VNT, 50.2% with viral hepatitis, 28.9% with nonalcoholic fatty liver disease, 20.8% with alcohol-associated liver disease, with model for end-stage liver disease scores of 9.5 ± 3.0, and 93.0% with liver stiffness measurements ≥10 kPa) or a validation population (n = 789). Test results were compared with results from a sequential algorithm (VariScreen). VariScreen incorporated data on platelets or liver stiffness measurements and then the ratio of platelets to liver stiffness measurement, adjusted for etiology, patient sex, and international normalized ratio. RESULTS In the derivation population, endoscopies were spared for 23.9% of patients using the B6C (VNT missed in 2.9%), 24.3% of patients using the ANTICIPATE score (VNT missed in 4.6%), 34.5% of patients using VariScreen (VNT missed in 2.9%), and 41.9% of patients using the EB6C (VNT missed in 10.9%). Differences in spared endoscopy rates were significant (P ≤ .001), except for B6C vs ANTICIPATE and in missed VNT only for EB6C vs the others (P ≤ .009). VariScreen was the only safe test regardless of sex or etiology (missed VNT ≤5%). Moreover, VariScreen secured screening without missed VNT in patients with model for end-stage liver disease scores higher than 10. This overall strategy performed better than a selective strategy restricted to patients with compensated liver disease. Test performance and safety did not differ significantly among populations. CONCLUSIONS In a retrospective study of data from 2368 patients with chronic liver disease, we found that the B6C are safe whereas the EB6C are unsafe, based on missed VNT. The VariScreen algorithm performed well in patients with chronic liver disease of any etiology or severity. It is the only test that safely rules out VNT and can be used in clinical practice.
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Affiliation(s)
- Arthur Berger
- Hepato-Gastroenterology Department, University Hospital, Angers, France; Hepatic Interaction Fibrosis Tumor Invasiveness Hemodynamics Laboratory, Unité Propre de Recherche de l'enseignement Supérieur 3859, University Angers, France
| | - Federico Ravaioli
- Gastroenterology and Hepatology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Oana Farcau
- Liver Unit, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Davide Festi
- Gastroenterology and Hepatology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Horia Stefanescu
- Liver Unit, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - François Buisson
- Hepato-Gastroenterology Department, University Hospital, Angers, France; Hepatic Interaction Fibrosis Tumor Invasiveness Hemodynamics Laboratory, Unité Propre de Recherche de l'enseignement Supérieur 3859, University Angers, France
| | - Pierre Nahon
- Hepato-Gastroenterology Department, Paris Seine-Saint-Denis University Hospitals, Assistance Publique des Hôpitaux de Paris, Jean Verdier Hospital, Bondy, France; University Paris 13, Bobigny, France; INSERM Unité Mixte de Recherche 1162, Paris, France
| | - Christophe Bureau
- Hepato-Gastroenterology Department, Purpan University Hospital, Toulouse, France
| | - Nathalie Ganne-Carriè
- Hepato-Gastroenterology Department, Paris Seine-Saint-Denis University Hospitals, Assistance Publique des Hôpitaux de Paris, Jean Verdier Hospital, Bondy, France; University Paris 13, Bobigny, France; INSERM Unité Mixte de Recherche 1162, Paris, France
| | - Annalisa Berzigotti
- Hepatology, Swiss Liver Center, Visceral Surgery and Medicine Clinic, Inselspital, University of Bern, Bern, Switzerland
| | | | - Salvatore Petta
- Department of Gastroenterology and Hepatology, PROMISE, University of Palermo, Palermo, Italy
| | - Paul Calès
- Hepato-Gastroenterology Department, University Hospital, Angers, France; Hepatic Interaction Fibrosis Tumor Invasiveness Hemodynamics Laboratory, Unité Propre de Recherche de l'enseignement Supérieur 3859, University Angers, France; INSERM Unité Mixte de Recherche 1162, Paris, France.
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Stefanescu H, Marasco G, Calès P, Fraquelli M, Rosselli M, Ganne-Carriè N, de Ledinghen V, Ravaioli F, Colecchia A, Rusu C, Andreone P, Mazzella G, Festi D. A novel spleen-dedicated stiffness measurement by FibroScan® improves the screening of high-risk oesophageal varices. Liver Int 2020; 40:175-185. [PMID: 31444849 DOI: 10.1111/liv.14228] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/23/2019] [Accepted: 08/20/2019] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS Several non-invasive tests (NITs) have been developed to diagnose oesophageal varices (EV), including the recent Baveno VI criteria to rule out high-risk varices (HRV). Spleen stiffness measurement (SSM) with the standard FibroScan® (SSM@50Hz) has been evaluated. However, the EV grading could be underestimated because of a ceiling threshold (75 kPa) of the SSM@50Hz. The aims were to evaluate SSM by a novel spleen-dedicated FibroScan® (SSM@100Hz) for EV diagnosis compared with SSM@50Hz, other validated NITs and Baveno VI criteria. METHODS This prospective multicentre study consecutively enrolled patients with chronic liver disease; blood data, endoscopy, liver stiffness measurement (LSM), SSM@50Hz and SSM@100Hz were collected. RESULTS Two hundred and sixty patients met inclusion criteria. SSM@100Hz success rate was significantly higher than that of SSM@50Hz (92.5% vs 76.0%, P < .001). SSM@100Hz accuracy for the presence of EV (AUC = 0.728) and HRV (AUC = 0.756) was higher than in other NITs. SSM@100Hz AUC for large EV (0.782) was higher than SSM@50Hz (0.720, P = .027). AUC for HRV with SSM@100Hz (0.780) was higher than with LSM (0.615, P < .001). The spared endoscopy rate of Baveno VI criteria (8.1%) was significantly increased by the combination to SSM@50Hz (26.5%) or SSM@100Hz (38.9%, P < .001 vs others). The missed HRV rate was, respectively, 0% and 4.7% for combinations. CONCLUSIONS SSM@100Hz is a new performant non-invasive marker for EV and HRV providing a higher accuracy than SSM@50Hz and other NITs. The combination of Baveno VI criteria and SSM@100Hz significantly increased the spared endoscopy rate compared to Baveno VI criteria alone or combined with SSM@50Hz. Clinical trial number: NCT02180113.
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Affiliation(s)
- Horia Stefanescu
- Liver Unit, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Giovanni Marasco
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Paul Calès
- Hepato-Gastroenterology Department, University hospital, Angers, France
| | - Mirella Fraquelli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Rosselli
- Institute for Liver and Digestive Health, Royal Free Hospital, University College of London, London, UK
| | - Nathalie Ganne-Carriè
- INSERM UMR 1162, Hepato-Gastroenterology Department, APHP Jean Verdier Hospital, University Paris 13, Paris, France
| | | | - Federico Ravaioli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Antonio Colecchia
- Gastroenterology Unit, University Hospital Borgo Trento, Verona, Italy
| | - Corina Rusu
- Liver Unit, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Pietro Andreone
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Giuseppe Mazzella
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Davide Festi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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