Validation and Comparison of Non-Invasive Tests for the Exclusion of High-Risk Varices in Compensated Advanced Chronic Liver Disease
Abstract
:1. Introduction
2. Methods
2.1. Data Collection
2.1.1. Transient Elastography
2.1.2. Calculation of NIT Indices
- -
- FIB-4 [20] = (age [years] × AST [U/L])/(PLT [109/L] × ALT [U/L]1/2)
- -
- APRI [21] = ((AST [U/L]/ULN)/PLT [×109/L])) × 100
- -
- MELD [18] = 0.957 × Logₑ(creatinine [mg/dL]) + 0.378 × Logₑ(bilirubin [mg/dL]) + 1.120 × Logₑ(INR) + 0.643
- -
- MELD-Na [19] = MELD − Na − 0.025 × MELD × (140 − Na) + 140
- -
- FIPS [16] = 1.43 × log10 (bilirubin [mg/dL]) − 1.71/(creatinine [mg/dL]) + 0.02 × (age [years]) − 0.02 × (albumin [g/L])
- -
- EVendo [15] = ((8.5 × INR + AST [U/L]/35)/(PLT [×103/μL]/150) + (blood urea nitrogen [mg/dL]/20) + (Hb [g/dL]/15)) + 1 if ascites present
- -
- B6C for excluding HRVs was used as described in the Baveno VI consensus (PLT > 150 × 109/L and LSM < 20 kPa) [11].
- -
- E6BC was used as proposed by Augustin et al. (PLT > 110 × 109/L and LSM < 25 kPa) [12].
2.1.3. Assessment of Varices
2.2. Statistical Analyses
3. Results
3.1. Baseline Characteristics
3.2. Performance and Safety of the NITs in Patients with cACLD
3.3. Performance and Safety of B6C and EVendo in cACLD Subgroups
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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All Patients (n = 210) | No HRVs (n = 184) | HRVs (n = 26) | p Value | |
---|---|---|---|---|
Age (years) | 57 (49–64) | 57 (49.25–64) | 58.5 (48.5–62.25) | 0.809 |
Male, n (%) | 138 (65.7) | 118 (64.1) | 20 (76.9) | 0.198 |
Aetiology, n (%) ALD NAFLD HBV HCV Other | 33 (15.7) 66 (31.4) 12 (5.7) 88 (41.9) 11 (5.3) | 29 (15.8) 55 (29.9) 12 (6.5) 78 (42.4) 10 (5.4) | 4 (15.4) 11 (42.3) 0 (0) 10 (38.5) 1 (3.8) | 0.578 |
LSM (kPA) | 20.25 (12.8–32.45) | 19.9 (12.83–31.1) | 25.2 (12.65–35.3) | 0.551 |
Hb (g/L) | 140.5 (124.75–150.25) | 145.5 (126.75–151) | 140 (119–154.5) | 0.023 |
WCC (×109/L) | 5.9 (4.4–7.6) | 5.95 (4.375–7.675) | 4.3 (3.8–5.9) | 0.017 |
PLT (×109/L) | 149.5 (91.25–202.25) | 135 (79.75–181.75) | 89 (61–124.5) | <0.001 |
Bilirubin (µmol/L) | 12 (8–20) | 10 (8.25–15.75) | 16 (12–28) | 0.004 |
Albumin (g/L) | 37 (34–40) | 38 (36–39.75) | 35 (29–38) | 0.128 |
ALT (U/L) | 46 (29–77) | 54.5 (35.25–86.75) | 43 (34.5–84) | 0.988 |
AST (U/L) | 44 (30–79) | 44 (34.75–78.75) | 75 (42.5–106.5) | 0.406 |
Na (mmol/L) | 139 (138–141) | 139 (138–140) | 140 (136.5–141) | 0.415 |
Creatinine (µmol/L) | 64 (55–76) | 64 (55–76.5) | 63 (50–68) | 0.207 |
Urea (mmol/L) | 4.5 (3.4–5.8) | 4.8 (3.7–6.25) | 3.8 (2.6–4.85) | 0.743 |
Fe (µg/L) | 115 (46.5–311) | 112.5 (50.25–319) | 206 (35–260) | 0.897 |
INR | 1.1 (1–1.2) | 1.1 (1–1.2) | 1.2 (1.05–1.25) | 0.009 |
AFP (IU/mL) | 3 (2–7) | 3 (2–6.75) | 6 (3–7.5) | 0.150 |
Child–Pugh Class, n (%) | 0.492 | |||
A | 193 (91.9) | 170 (92.4) | 23 (88.5) | |
B | 17 (8.1) | 14 (7.6) | 3 (11.5) |
Variable | Univariate Analysis | Multivariate Analysis | ||||||
---|---|---|---|---|---|---|---|---|
β | OR | 95% CI | p Value | β | OR | 95% CI | p Value | |
WCC | −0.476 | 0.621 | 0.477–0.808 | <0.001 * | ||||
PLT | −0.019 | 0.981 | 0.972–0.990 | <0.001 * | −0.019 | 0.981 | 0.972–0.990 | <0.001 * |
Bilirubin | 0.036 | 1.037 | 1.003–1.072 | 0.032 |
Cut-Off | AUC | Sensitivity | Specificity | PPV | NPV | +LR | −LR | |
---|---|---|---|---|---|---|---|---|
Baveno VI | PLT > 150 and LSM < 20 | 0.671 | 96.2 | 38 | 18 | 98.6 | 1.55 | 0.1 |
Expanded Baveno | PLT > 110 and LSM < 25 | 0.654 | 76.9 | 53.8 | 19 | 94.3 | 1.66 | 0.43 |
FIB4 | 4.409 | 0.744 | 65.4 | 76.1 | 27.9 | 94 | 2.74 | 0.45 |
APRI | 1.372 | 0.685 | 65.4 | 71.7 | 24.6 | 93.6 | 2.31 | 0.48 |
FIPS | −2.762 | 0.5 | 80.8 | 31 | 14.2 | 91.9 | 1.17 | 0.62 |
MELD | 7.5 | 0.620 | 73.1 | 52.2 | 17.8 | 93.2 | 1.53 | 0.52 |
MELD-Na | 8.5 | 0.615 | 73.1 | 45.1 | 15.8 | 92.2 | 1.33 | 0.6 |
EVendo | 3.9 | 0.662 | 88.5 | 44 | 18.3 | 95.4 | 1.58 | 0.26 |
Cut-Off | Spared OGD (%) | Missed HRVs (%) | |
---|---|---|---|
Baveno VI | PLT > 150 and LSM < 20 | 33.8 | 1.41 |
Expanded Baveno | PLT > 110 and LSM < 25 | 50 | 5.71 |
FIB4 | 4.409 | 71 | 6.04 |
APRI | 1.372 | 67.1 | 6.38 |
FIPS | −2.762 | 29.5 | 8.06 |
MELD | 7.5 | 49 | 6.8 |
MELD-Na | 8.5 | 42.8 | 7.77 |
EVendo | 3.9 | 40 | 3.57 |
Spared OGD (%) | Missed HRVs (%) | |||
---|---|---|---|---|
B6C | EVendo | B6C | EVendo | |
HBV | 50% (6/12) | 50% (6/12) | 0% (0/6) | 0% (0/6) |
HCV | 31.8% (28/88) | 30.7% (27/88) | 0% (0/28) | 0% (0/27) |
ALD | 21.2% (7/33) | 30.3% (10/33) | 0% (0/7) | 0% (0/10) |
NAFLD | 43.9% (29/66) | 56.1% (37/66) | 3.4% (1/29) | 8.1% (3/37) |
Other | 9.1% (1/11) | 36.4% (4/11) | 0% (0/1) | 0% (0/4) |
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Kurup, R.; Kalo, E.; Read, S.; Ma, W.S.; George, J.; Ahlenstiel, G. Validation and Comparison of Non-Invasive Tests for the Exclusion of High-Risk Varices in Compensated Advanced Chronic Liver Disease. Livers 2024, 4, 182-192. https://doi.org/10.3390/livers4020014
Kurup R, Kalo E, Read S, Ma WS, George J, Ahlenstiel G. Validation and Comparison of Non-Invasive Tests for the Exclusion of High-Risk Varices in Compensated Advanced Chronic Liver Disease. Livers. 2024; 4(2):182-192. https://doi.org/10.3390/livers4020014
Chicago/Turabian StyleKurup, Rajiv, Eric Kalo, Scott Read, Wai See Ma, Jacob George, and Golo Ahlenstiel. 2024. "Validation and Comparison of Non-Invasive Tests for the Exclusion of High-Risk Varices in Compensated Advanced Chronic Liver Disease" Livers 4, no. 2: 182-192. https://doi.org/10.3390/livers4020014
APA StyleKurup, R., Kalo, E., Read, S., Ma, W. S., George, J., & Ahlenstiel, G. (2024). Validation and Comparison of Non-Invasive Tests for the Exclusion of High-Risk Varices in Compensated Advanced Chronic Liver Disease. Livers, 4(2), 182-192. https://doi.org/10.3390/livers4020014