Prediction of the varices needing treatment with non-invasive tests in patients with compensated advanced chronic liver disease

Han Ah Lee, Seungup Kim, Yeon Seok Seo, Young Sun Lee, Seong Hee Kang, Young Kul Jung, Moonyoung Kim, Ji Hoon Kim, Sang Gyune Kim, Ki Tae Suk, Soung Won Jung, Jae Young Jang, Hyonggin An, Hyung Joon Yim, Soon Ho Um

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Backgrounds & Aims: The Baveno VI guidelines proposed criteria including liver stiffness (LS) and platelet count to avoid screening endoscopy in patients with compensated advanced chronic liver disease (cACLD). This study was performed to validate the Baveno IV criteria and to compare its diagnostic accuracy with other non-invasive models. Methods: Patients with cACLD who underwent laboratory tests, upper gastrointestinal endoscopy and abdominal ultrasound within 6 months of transient elastography were included. Results: A total of 1218 patients with cACLD were included. VNT occurred in 249 patients (20.4%). With the Baveno VI criteria, the VNT miss rate was 1.9% with a 25.7% saved endoscopy rate. Using two criteria of LS <20 kPa and platelet count >110 × 109 cells/L or LS <25 kPa and platelet count >120 × 109 cells/L, the saved endoscopy rate was 39.1% while maintaining the VNT miss rate <5%. The optimal LS and platelet count-based criteria for predicting VNT differed according to the underlying liver disease. The area under the receiver operating characteristic curve of LS-spleen diameter to platelet score (LSPS) was 0.780 (95% confidence interval: 0.774-0.820), which was significantly higher than other models. The optimal cut-off value of the LSPS for predicting VNT was 1.47. Conclusion: Liver stiffness and platelet count-based criteria are useful for discriminating patients with very low risk of having VNT among patients with cACLD and are partly affected by the type of underlying liver disease. Conversely, the LSPS is a predictor of VNT in patients with cACLD regardless of the type of underlying liver disease.

Original languageEnglish
Pages (from-to)1071-1079
Number of pages9
JournalLiver International
Volume39
Issue number6
DOIs
Publication statusPublished - 2019 Jun 1

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Varicose Veins
Liver Diseases
Chronic Disease
Liver
Platelet Count
Endoscopy
Blood Platelets
Spleen
Therapeutics
Elasticity Imaging Techniques
Gastrointestinal Endoscopy
ROC Curve
Guidelines
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Hepatology

Cite this

Lee, Han Ah ; Kim, Seungup ; Seo, Yeon Seok ; Lee, Young Sun ; Kang, Seong Hee ; Jung, Young Kul ; Kim, Moonyoung ; Kim, Ji Hoon ; Kim, Sang Gyune ; Suk, Ki Tae ; Jung, Soung Won ; Jang, Jae Young ; An, Hyonggin ; Yim, Hyung Joon ; Um, Soon Ho. / Prediction of the varices needing treatment with non-invasive tests in patients with compensated advanced chronic liver disease. In: Liver International. 2019 ; Vol. 39, No. 6. pp. 1071-1079.
@article{c64a553fd29146058210bf2396a1b964,
title = "Prediction of the varices needing treatment with non-invasive tests in patients with compensated advanced chronic liver disease",
abstract = "Backgrounds & Aims: The Baveno VI guidelines proposed criteria including liver stiffness (LS) and platelet count to avoid screening endoscopy in patients with compensated advanced chronic liver disease (cACLD). This study was performed to validate the Baveno IV criteria and to compare its diagnostic accuracy with other non-invasive models. Methods: Patients with cACLD who underwent laboratory tests, upper gastrointestinal endoscopy and abdominal ultrasound within 6 months of transient elastography were included. Results: A total of 1218 patients with cACLD were included. VNT occurred in 249 patients (20.4{\%}). With the Baveno VI criteria, the VNT miss rate was 1.9{\%} with a 25.7{\%} saved endoscopy rate. Using two criteria of LS <20 kPa and platelet count >110 × 109 cells/L or LS <25 kPa and platelet count >120 × 109 cells/L, the saved endoscopy rate was 39.1{\%} while maintaining the VNT miss rate <5{\%}. The optimal LS and platelet count-based criteria for predicting VNT differed according to the underlying liver disease. The area under the receiver operating characteristic curve of LS-spleen diameter to platelet score (LSPS) was 0.780 (95{\%} confidence interval: 0.774-0.820), which was significantly higher than other models. The optimal cut-off value of the LSPS for predicting VNT was 1.47. Conclusion: Liver stiffness and platelet count-based criteria are useful for discriminating patients with very low risk of having VNT among patients with cACLD and are partly affected by the type of underlying liver disease. Conversely, the LSPS is a predictor of VNT in patients with cACLD regardless of the type of underlying liver disease.",
author = "Lee, {Han Ah} and Seungup Kim and Seo, {Yeon Seok} and Lee, {Young Sun} and Kang, {Seong Hee} and Jung, {Young Kul} and Moonyoung Kim and Kim, {Ji Hoon} and Kim, {Sang Gyune} and Suk, {Ki Tae} and Jung, {Soung Won} and Jang, {Jae Young} and Hyonggin An and Yim, {Hyung Joon} and Um, {Soon Ho}",
year = "2019",
month = "6",
day = "1",
doi = "10.1111/liv.14036",
language = "English",
volume = "39",
pages = "1071--1079",
journal = "Liver International",
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Lee, HA, Kim, S, Seo, YS, Lee, YS, Kang, SH, Jung, YK, Kim, M, Kim, JH, Kim, SG, Suk, KT, Jung, SW, Jang, JY, An, H, Yim, HJ & Um, SH 2019, 'Prediction of the varices needing treatment with non-invasive tests in patients with compensated advanced chronic liver disease', Liver International, vol. 39, no. 6, pp. 1071-1079. https://doi.org/10.1111/liv.14036

Prediction of the varices needing treatment with non-invasive tests in patients with compensated advanced chronic liver disease. / Lee, Han Ah; Kim, Seungup; Seo, Yeon Seok; Lee, Young Sun; Kang, Seong Hee; Jung, Young Kul; Kim, Moonyoung; Kim, Ji Hoon; Kim, Sang Gyune; Suk, Ki Tae; Jung, Soung Won; Jang, Jae Young; An, Hyonggin; Yim, Hyung Joon; Um, Soon Ho.

In: Liver International, Vol. 39, No. 6, 01.06.2019, p. 1071-1079.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Prediction of the varices needing treatment with non-invasive tests in patients with compensated advanced chronic liver disease

AU - Lee, Han Ah

AU - Kim, Seungup

AU - Seo, Yeon Seok

AU - Lee, Young Sun

AU - Kang, Seong Hee

AU - Jung, Young Kul

AU - Kim, Moonyoung

AU - Kim, Ji Hoon

AU - Kim, Sang Gyune

AU - Suk, Ki Tae

AU - Jung, Soung Won

AU - Jang, Jae Young

AU - An, Hyonggin

AU - Yim, Hyung Joon

AU - Um, Soon Ho

PY - 2019/6/1

Y1 - 2019/6/1

N2 - Backgrounds & Aims: The Baveno VI guidelines proposed criteria including liver stiffness (LS) and platelet count to avoid screening endoscopy in patients with compensated advanced chronic liver disease (cACLD). This study was performed to validate the Baveno IV criteria and to compare its diagnostic accuracy with other non-invasive models. Methods: Patients with cACLD who underwent laboratory tests, upper gastrointestinal endoscopy and abdominal ultrasound within 6 months of transient elastography were included. Results: A total of 1218 patients with cACLD were included. VNT occurred in 249 patients (20.4%). With the Baveno VI criteria, the VNT miss rate was 1.9% with a 25.7% saved endoscopy rate. Using two criteria of LS <20 kPa and platelet count >110 × 109 cells/L or LS <25 kPa and platelet count >120 × 109 cells/L, the saved endoscopy rate was 39.1% while maintaining the VNT miss rate <5%. The optimal LS and platelet count-based criteria for predicting VNT differed according to the underlying liver disease. The area under the receiver operating characteristic curve of LS-spleen diameter to platelet score (LSPS) was 0.780 (95% confidence interval: 0.774-0.820), which was significantly higher than other models. The optimal cut-off value of the LSPS for predicting VNT was 1.47. Conclusion: Liver stiffness and platelet count-based criteria are useful for discriminating patients with very low risk of having VNT among patients with cACLD and are partly affected by the type of underlying liver disease. Conversely, the LSPS is a predictor of VNT in patients with cACLD regardless of the type of underlying liver disease.

AB - Backgrounds & Aims: The Baveno VI guidelines proposed criteria including liver stiffness (LS) and platelet count to avoid screening endoscopy in patients with compensated advanced chronic liver disease (cACLD). This study was performed to validate the Baveno IV criteria and to compare its diagnostic accuracy with other non-invasive models. Methods: Patients with cACLD who underwent laboratory tests, upper gastrointestinal endoscopy and abdominal ultrasound within 6 months of transient elastography were included. Results: A total of 1218 patients with cACLD were included. VNT occurred in 249 patients (20.4%). With the Baveno VI criteria, the VNT miss rate was 1.9% with a 25.7% saved endoscopy rate. Using two criteria of LS <20 kPa and platelet count >110 × 109 cells/L or LS <25 kPa and platelet count >120 × 109 cells/L, the saved endoscopy rate was 39.1% while maintaining the VNT miss rate <5%. The optimal LS and platelet count-based criteria for predicting VNT differed according to the underlying liver disease. The area under the receiver operating characteristic curve of LS-spleen diameter to platelet score (LSPS) was 0.780 (95% confidence interval: 0.774-0.820), which was significantly higher than other models. The optimal cut-off value of the LSPS for predicting VNT was 1.47. Conclusion: Liver stiffness and platelet count-based criteria are useful for discriminating patients with very low risk of having VNT among patients with cACLD and are partly affected by the type of underlying liver disease. Conversely, the LSPS is a predictor of VNT in patients with cACLD regardless of the type of underlying liver disease.

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U2 - 10.1111/liv.14036

DO - 10.1111/liv.14036

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C2 - 30589490

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JO - Liver International

JF - Liver International

SN - 1478-3223

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