Noninvasive tools and risk of clinically significant portal hypertension and varices in compensated cirrhosis: The "Anticipate" study - PubMed (original) (raw)
. 2016 Dec;64(6):2173-2184.
doi: 10.1002/hep.28824. Epub 2016 Oct 27.
Affiliations
- PMID: 27639071
- DOI: 10.1002/hep.28824
Noninvasive tools and risk of clinically significant portal hypertension and varices in compensated cirrhosis: The "Anticipate" study
Juan G Abraldes et al. Hepatology. 2016 Dec.
Erratum in
- Correction.
[No authors listed] [No authors listed] Hepatology. 2017 Jul;66(1):304-305. doi: 10.1002/hep.29201. Epub 2017 Jun 9. Hepatology. 2017. PMID: 28640978 No abstract available.
Abstract
In patients with compensated advanced chronic liver disease (cACLD), the presence of clinically significant portal hypertension (CSPH) and varices needing treatment (VNT) bears prognostic and therapeutic implications. Our aim was to develop noninvasive tests-based risk prediction models to provide a point-of-care risk assessment of cACLD patients. We analyzed 518 patients with cACLD from five centers in Europe/Canada with paired noninvasive tests (liver stiffness measurement [LSM] by transient elastography, platelet count, and spleen diameter with calculation of liver stiffness to spleen/platelet score [LSPS] score and platelet-spleen ratio [PSR]) and endoscopy/hepatic venous pressure gradient measurement. Risk of CSPH, varices, and VNT was modeled with logistic regression. All noninvasive tests reliably identified patients with high risk of CSPH, and LSPS had the highest discrimination. LSPS values above 2.65 were associated with risks of CSPH above 80%. None of the tests identified patients with very low risk of all-size varices, but both LSPS and a model combining TE and platelet count identified patients with very low risk (<5%) risk of VNT, suggesting that they could be used to triage patients requiring screening endoscopy. LSPS values of <1.33 were associated with a <5% risk of VNT, and 26% of patients had values below this threshold. LSM combined with platelet count predicted a risk <5% of VNT in 30% of the patients. Nomograms were developed to facilitate point-of-care risk assessment.
Conclusion: A significant proportion of patients with a very high risk of CSPH, and a population with a very low risk of VNT can be identified with simple, noninvasive tests, suggesting that these can be used to individualize medical care. (Hepatology 2016;64:2173-2184).
© 2016 by the American Association for the Study of Liver Diseases.
Comment in
- Reply.
Abraldes JG, Berzigotti A; ANTICIPATE INVESTIGATORS. Abraldes JG, et al. Hepatology. 2017 Jun;65(6):2131-2132. doi: 10.1002/hep.29083. Epub 2017 Apr 28. Hepatology. 2017. PMID: 28130816 No abstract available. - Noninvasive assessment of varices needing treatment in patients with advanced chronic liver disease: No one should be left behind.
Giannini EG, Savarino V. Giannini EG, et al. Hepatology. 2017 Jun;65(6):2131. doi: 10.1002/hep.29087. Epub 2017 Apr 24. Hepatology. 2017. PMID: 28142192 No abstract available.
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