Individual and population screening of varices needing treatment by a simple, safe and accurate test - 27/04/23
, Arthur Berger 2, # , Oana Farcau 3 , Antonio Colecchia 1, 2, 3, 4 , Horia Stefanescu 3 , Camille Candillier 2 , Pierre Nahon 5 , Christophe Bureau 6 , Nathalie Ganne-Carriè 5 , Annalisa Berzigotti 7 , Victor de Ledinghen 8 , Salvatore Petta 9 , Paul Calès 2, ⁎ , multicentric groups 10, Bologna 1, Cluj 3, Bondy 5, Toulouse 6, Bern 7, Bordeaux 8, Palermo 9Highlights |
• | Endoscopy to screen varices needing treatment can be avoided by non-invasive markers in a minority of patients. A new LIP test, designed for mains etiologies, spared 33% of endoscopies in population screening and 54% in individual screening. A new BLIP test, designed for NAFLD, spared 41% of endoscopies in population screening and 75% in individual screening. This new strategy, adapted to clinical practice, should improve screening adherence which is currently poor. |
Abstract |
Background |
Several tests have been developed to screen varices needing treatment (VNT) in different screening settings. We aimed to develop simple estimators to quantify VNT risk and spare endoscopy while missing <5% of VNT, adapted to different screenings in the main etiologies.
Methods |
2,368 patients with chronic liver disease were included. The main VNT predictors were platelets, prothrombin index (PI) and LSM. Their interactions led to score construction, LIP: (LSM*45)/(PI*platelets), and BLIP: BMI-adjusted LIP in NAFLD. Scores were categorized either for population (VNT sensitivity ≥95%) or individual (negative predictive value ≥95%) VNT screening.
Results |
1) Scores diagnosing VNT. AUROCs were, PLER: 0.767 Anticipate: 0.773 (p=0.059 vs previous), LIP: 0.779 (p=0.136), PLEASE: 0.789 (p=0.196). 2) Population screening performance was in increasing order (with missed VNT rate), Baveno6 criteria: 23.9% (2.5%), Anticipate: 24.5%, p=0.367 vs previous (3.3%), PLER: 27.3%, p<0.001 (3.6%), LIP: 33.4%, p<0.001 (4.2%), PLEASE: 35.2%, p=0.006 (3.6%). In NAFLD, LIP: 38.6%, BLIP: 40.8%, p=0.038. 3) Individual screening performance was, expanded Baveno6 criteria: 42.7%, LIP: 54.1%, p<0.001. In NAFLD, performance was, NAFLD-cirrhosis criteria: 66.7%, BLIP: 74.6%, p<0.001.
Conclusion |
LIP combined simplicity, performance and safety in each etiology. In NAFLD, BMI-adjusted LIP outperformed other tests.
Le texte complet de cet article est disponible en PDF.Keywords : Portal hypertension, esophageal varices, platelets, liver elastometry, prothrombin time
Abbreviations : ALD, AUROC, cACLD, CI, CLD, EV, INR, LR, LSM, MELD, NAFLD, NPV, PI, PLER, PLEASE, PPV, VCTE, VNT
Plan
| Writing assistance: Kevin L. Erwin for English proofreading (institutional support) |
Vol 47 - N° 5
Article 102123- mai 2023 Retour au numéro
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