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Including Ratio of Platelets to Liver Stiffness Improves Accuracy of Screening for Esophageal Varices That Require Treatment

Arthur Berger 1, 2 Federico Ravaioli 3 Oana Farcau 4 Davide Festi 3 Horia Stefanescu 4 François Buisson 1, 2 Nathalie Ganne-Carriè Annalisa Berzigotti Salvatore Petta Sylvie Sacher Huvelin Dominique Valla Christophe Bureau Anne Olivier Frédéric Oberti Jérôme Boursier Jean Paul Galmiche Jean Pierre Vinel Clotilde Duburque Alain Attar Isabelle Archambeaud Robert Benamouzig Marianne Gaudric Dominique Luet Patrice Couzigou Lucie Planche Emmanuel Coron Jean-Baptiste Hiriart Faiza Chermak Maude Charbonnier Pierre Nahon 5, 6, 7 Patrick Marcellin Dominique Guyader Stanislas Pol 8, 9 Hélène Fontaine Dominique Larrey Victor de Ledinghen Denis Ouzan Fabien Zoulim Dominique Roulot Albert Tran Jean-Pierre Bronowicki Jean-Pierre Zarski Vincent Leroy Ghassan Riachi Paul Calès Jean-Marie Péron Laurent Alric Marc Bourlière Philippe Mathurin Sebastien Dharancy Jean-Frédéric Blanc Armand Abergel Lawrence Serfaty Ariane Mallat Jean-Didier Grangé Pierre Attali Yannick Bacq Claire Wartelle Thông Dao Yves Benhamou Christophe Pilette Christine Silvain Christos Christidis Dominique Capron Gérard Thiefin Sophie Hillaire Vincent Di Martino
Abstract : 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.
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Submitted on : Friday, June 11, 2021 - 1:32:27 PM
Last modification on : Tuesday, July 13, 2021 - 3:27:27 AM

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Arthur Berger, Federico Ravaioli, Oana Farcau, Davide Festi, Horia Stefanescu, et al.. Including Ratio of Platelets to Liver Stiffness Improves Accuracy of Screening for Esophageal Varices That Require Treatment. Clinical Gastroenterology and Hepatology, WB Saunders, 2021, 19 (4), pp.777-787.e17. ⟨10.1016/j.cgh.2020.06.022⟩. ⟨hal-03258178⟩

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