Department of Gastroenterology and Hepatology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.
Department of Functional Sciences, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.
Med Ultrason. 2021 Aug 11;23(3):265-270. doi: 10.11152/mu-2929. Epub 2021 Mar 3.
The updated Baveno VI guidelines recommend that screening for high-risk varices (HRV) by esophago-gastro-duodenoscopy (EGD) can be avoided in patients with compensated advanced chronic liver disease (cACLD) who have liver stiffness LSM<20 kPa and platelet count PLT>150,000/L. The aims of this study were to validate extended Baveno VI criteria in patients with chronic liver disease and to establish cut-off values for our cohort.
This retrospective study included 839 patients with liver cirrhosis evaluated by Transient Elastography (TE), biological tests, and upper endos-copy, all within one year. The Baveno VI criteria were validated on a sub-group of 728 patients (Cohort 1, randomly selected from the study sample) and tailored cut-off points were determined. The remaining 111 patients comprised the validating set (Cohort 2) for these specific cut-off values.
In Cohort 1, Baveno VI criteria had 86.2% accuracy. The calculated cut-offs to rule-in HRV were PLT<150,000/mm3 and LSM >35.3 kPa; while to rule-out HRV they were PLT >150.000/mm3 and LSM <19.6 kPa. In patients in the "grey-zone", by multivariate analysis, albumin was independently associated with HRV at a cut-off of ˂3.4 g/dl. In the validation cohort, the calculated rule out cut-offs had 100% accuracy.
The Baveno VI criteria had a good accuracy for exclusion of HRV in this large cohort of cirrhotic patients. Adding an albumin-related threshold increased performance and broadened applicability. Using the calculated rule-out criteria for HRV, all unnecessary EGD could be excluded.
更新的贝伦诺六指南建议，对于肝功能代偿的晚期慢性肝病（cACLD）患者，如果肝脏硬度 LSM<20kPa 和血小板计数 PLT>150,000/L，则可以避免通过食管胃十二指肠镜（EGD）筛查高危静脉曲张（HRV）。本研究的目的是验证慢性肝病患者扩展的贝伦诺六标准，并为我们的队列确定截断值。
这项回顾性研究包括 839 名通过瞬时弹性成像（TE）、生物检测和上内窥镜检查评估的肝硬化患者，所有检查均在一年内进行。贝伦诺六标准在 728 名患者的亚组（从研究样本中随机选择的队列 1）中进行了验证，并确定了定制的截断值。其余 111 名患者构成了这些特定截断值的验证集（队列 2）。
在队列 1 中，贝伦诺六标准的准确率为 86.2%。计算出的 PLT<150,000/mm3 和 LSM>35.3kPa 用于排除 HRV；而 PLT>150,000/mm3 和 LSM<19.6kPa 用于排除 HRV。在“灰色地带”的患者中，通过多变量分析，白蛋白与 HRV 的相关性独立于白蛋白截断值<3.4g/dl。在验证队列中，计算出的排除 HRV 的截断值具有 100%的准确性。
贝伦诺六标准在该大型肝硬化患者队列中对排除 HRV 具有良好的准确性。添加与白蛋白相关的阈值可提高性能并扩大适用性。使用计算出的排除 HRV 的标准，可以排除所有不必要的 EGD。
