Hepato-Gastroenterology Department, University Hospital, Angers, France; HIFIH laboratory, UPRES 3859, UNIV Angers, France.
Gastroenterology and Hepatology Unit, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.
Clin Res Hepatol Gastroenterol. 2022 Aug-Sep;46(7):101925. doi: 10.1016/j.clinre.2022.101925. Epub 2022 Apr 22.
We aimed to improve non-invasive screening of varices needing treatment (VNT) and compare different screening strategies.
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).
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).
VANT and VARS spared from 12% (undifferentiated screening) to 40% (population screening) or 62% (individual screening) of endoscopies in main-etiology patients without ascites.
本研究旨在改进需要治疗的静脉曲张的非侵入性筛查（VNT）并比较不同的筛查策略。
本回顾性研究纳入了 2290 例慢性肝病患者。病因包括：病毒：50.0%，非酒精性脂肪性肝病（NAFLD）：29.5%，酒精：20.5%，VNT：14.9%。测试描述符为性能（节省内镜检查）和安全性（漏诊 VNT）。根据其安全性水平，VNT 测试分别进行个体筛查（95%阴性预测值（NPV））、人群筛查（95%敏感性）或未分化筛查（100%敏感性/ NPV），以避免漏诊 VNT。这些测试提供了三个类别：漏诊 VNT<5%、VNT 100%特异性（新类别）、均节省内镜检查，以及中间（需要内镜检查）。
独立的 VNT 预测因素（病因、性别、年龄、血小板、凝血酶原指数、白蛋白、ALT、肝硬度）被纳入两项测试中：VNT 病毒酒精 NAFLD 测试（VANT）和静脉曲张风险评分（VARS）。我们报告了整个人群的结果。考虑到人群筛查，Baveno VI 标准的性能为 24.1%，Anticipate 为 24.7%，VariScreen 为 35.3%，VANT 为 40.2%（p<0.001 与其他测试相比）。在代偿性晚期慢性肝病患者中，VANT 比 Baveno 标准节省了 58.0%的内镜检查。考虑到个体筛查，VARS 的性能为，在所有患者中：扩大后的 Baveno VI 标准为 62.0%，比扩展后的 Baveno VI 标准为 42.9%（p<0.001），在 NAFLD 患者中：为 72.8%，比 NAFLD 肝硬化标准为 65.1%（p<0.001）。考虑到未分化筛查，VARS 的性能为 12%。VARS 评分估计 VNT 概率从 0 到 100%（AUROC：0.826）。
在主要病因患者中，VANT 和 VARS 分别从 12%（未分化筛查）到 40%（人群筛查）或 62%（个体筛查）的内镜检查中获益，且未出现腹水。
