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.

中文翻译：

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包括血小板与肝脏硬度的比率可提高筛查需要治疗的食管静脉曲张的准确性

背景与目标

基于血小板和肝脏硬度测量，Baveno VI 标准 (B6C)、扩展 B6C (EB6C) 和 ANTICIPATE 评分可用于排除代偿性慢性肝病患者需要治疗的静脉曲张 (VNT)。我们旨在通过纳入有关血小板与肝脏硬度比率的数据来改进这些测试。

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时，我们将 2368 名不同病因的慢性肝病患者的数据随机分配到衍生人群（n = 1579；15.1% 为 VNT，50.2% 为病毒性肝炎） ，28.9% 为非酒精性脂肪肝，20.8% 为酒精相关性肝病，终末期肝病模型评分为 9.5 ± 3.0，93.0% 肝硬度测量值≥10 kPa）或验证人群（n = 789）。将测试结果与顺序算法 (VariScreen) 的结果进行比较。VariScreen 结合了血小板或肝脏硬度测量的数据，然后结合了血小板与肝脏硬度测量的比率，根据病因、患者性别和国际标准化比率进行了调整。

结果

在衍生人群中，使用 B6C 的患者中有 23.9% 的患者（VNT 漏诊率为 2.9%）、使用 ANTICIPATE 评分的患者为 24.3%（4.6% 的 VNT 漏诊）、使用 VariScreen 的患者为 34.5%（VNT 漏诊率为2.9%），41.9% 的患者使用 EB6C（VNT 漏诊率为 10.9%）。在无一幸免内镜率差异有显著（P ≤0.001），除了B6C VS预计在错过VNT仅EB6C VS别人（P≤ .009）。无论性别或病因如何（漏诊 VNT ≤ 5%），VariScreen 都是唯一安全的测试。此外，VariScreen 确保在终末期肝病模型评分高于 10 的患者中进行筛查而不会遗漏 VNT。该总体策略的表现优于仅限于代偿性肝病患者的选择性策略。测试性能和安全性在人群中没有显着差异。

结论

在对 2368 名慢性肝病患者的数据进行的回顾性研究中，我们发现 B6C 是安全的，而 EB6C 是不安全的，基于漏诊的 VNT。VariScreen 算法在任何病因或严重程度的慢性肝病患者中均表现良好。这是唯一可以安全排除 VNT 并可用于临床实践的测试。