Berger Arthur, Ravaioli Federico, Farcau Oana, Festi Davide, Stefanescu Horia, Buisson François, Nahon Pierre, Bureau Christophe, Ganne-Carriè Nathalie, Berzigotti Annalisa, de Ledinghen Victor, Petta Salvatore, Calès Paul
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.
Gastroenterology and Hepatology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
Clin Gastroenterol Hepatol. 2021 Apr;19(4):777-787.e17. doi: 10.1016/j.cgh.2020.06.022. Epub 2020 Jun 17.
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.
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.
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.
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.
基于血小板和肝脏硬度测量结果，巴韦诺VI标准（B6C）、扩展巴韦诺VI标准（EB6C）和ANTICIPATE评分可用于排除代偿期慢性肝病患者中需要治疗的静脉曲张（VNT）。我们旨在通过纳入血小板与肝脏硬度比值的数据来改进这些检测方法。
在对2004年至2018年收集的10个研究人群的数据进行回顾性分析中，我们将2368例不同病因的慢性肝病患者的数据随机分配到一个推导人群（n = 1579；15.1%有VNT，50.2%有病毒性肝炎，28.9%有非酒精性脂肪性肝病，20.8%有酒精性肝病，终末期肝病模型评分为9.5±3.0，93.0%肝脏硬度测量值≥10 kPa）或一个验证人群（n = 789）。将检测结果与序贯算法（VariScreen）的结果进行比较。VariScreen纳入了血小板或肝脏硬度测量数据，然后是血小板与肝脏硬度测量值的比值，并根据病因、患者性别和国际标准化比值进行了调整。
在推导人群中，使用B6C可使23.9%的患者免于内镜检查（2.9%漏诊VNT），使用ANTICIPATE评分可使24.3%的患者免于内镜检查（4.6%漏诊VNT），使用VariScreen可使34.5%的患者免于内镜检查（2.9%漏诊VNT），使用EB6C可使41.9%的患者免于内镜检查（10.9%漏诊VNT）。免于内镜检查率的差异具有统计学意义（P≤0.001），B6C与ANTICIPATE之间以及仅EB6C与其他方法相比在漏诊VNT方面除外（P≤0.009）。无论性别或病因如何，VariScreen是唯一安全的检测方法（漏诊VNT≤5%）。此外，对于终末期肝病模型评分高于10分的患者，VariScreen确保了筛查且无VNT漏诊。这种总体策略比仅限于代偿期肝病患者的选择性策略表现更好。各人群之间的检测性能和安全性无显著差异。
在对2368例慢性肝病患者的数据进行的回顾性研究中，我们发现基于漏诊VNT，B6C是安全的，而EB6C是不安全的。VariScreen算法在任何病因或严重程度的慢性肝病患者中表现良好。它是唯一能安全排除VNT并可用于临床实践的检测方法。
