Novel albumin, bilirubin and platelet criteria for the exclusion of high-risk varices in compensated advanced chronic liver disease: A validation study - 11/11/21
, Guan Sen Kew b, 1, Poh Seng Tan b, 1, Zhaojin Chen c, Martin Putera a, Wenjun Alexander Yip b, Tiing Leong Ang a, d, Kwong Ming Fock a, d, Guan Huei Lee b, John Hsiang d, e, Daniel Q. Huang b, d, Andrew Kwek a, Mark D. Muthiah b, d, Rahul Kumar a, Malcolm Tan a, Jessica Tan a, Prem Harichander Thurairajah a, b, Eng Kiong Teo a, d, Bee Choo Tai f, 2, Seng Gee Lim b, d, 2Benvenuto su EM|consulte, il riferimento dei professionisti della salute.
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Highlights |
• | ABP (Albumin >40g/l, Bilirubin <22μmol/l and Platelet >114,000/μl) criteria is a novel, simple and validated criteria for the exclusion of high-risk varices (HRV). |
• | Using simple biochemical parameters, ABP criteria is a useful tool that is easily scalable in resource limited or pandemic settings to risk-stratify cACLD patients for screening gastroscopy. |
• | Among cACLD patients whom screening gastroscopy were spared, ABP criteria can be used for annual screening of HRV, without the need for transient elastography. |
Abstract |
Background and aims |
Availability of transient elastography (TE) limits the application of Baveno-VI criteria. In a derivation study, the ABP criteria (Albumin >40 g/l, Bilirubin <22 μmol/l and Platelet >114,000/μl) had been shown to perform well in identifying compensated advanced chronic liver disease (cACLD) patients without high-risk varices (HRV). We aim to externally validate this novel ABP criteria for the exclusion of HRVs among cACLD patients.
Methods |
Data was retrospectively collected from consecutive cACLD patients with paired TE and esophagogastroduodenoscopy (EGD) performed between 2011 and 2017 in Changi General Hospital, Singapore. We estimate the discriminative ability of ABP criteria in validation cohort using AUROC and calibration-in-the-large. We subsequently compare the performance between ABP and Baveno-VI criteria in the validation cohort.
Results |
Among 314 patients included in our validation cohort, 32 (10.2%) had HRV on screening EGD. Application of ABP criteria within this validation cohort has increased discriminative ability than the derivation cohort. The AUROC of validation and derivation cohort were 0.68 (0.60–0.76) and 0.66 (0.60–0.76), respectively. The mean and standard error for calibration-in-the-large and calibration slope were −0.08 (0.22) and 0.93 (0.26) respectively. The ABP criteria had excellent performance in excluding HRV and will spare more screening EGDs than the Baveno-VI criteria (39.2% vs 27.4%, p < 0.001), without missing more HRVs.
Conclusion |
We validated the performance of ABP criteria for the exclusion of HRVs in cACLD patients. ABP criteria is superior to Baveno-VI criteria by sparing more screening EGD without the need of TE.
Il testo completo di questo articolo è disponibile in PDF.Keywords : Liver cirrhosis, Gastrointestinal hemorrhage, Elastography, Screening, Gastroscopy, Esophageal and gastric varices
Abbreviations : ABP, cACLD, EGD, TE, LSM, HRV, SS, SP, NPV, PPV, LR+, LR−, SD, SE, AUROC, NSBB
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Vol 45 - N° 6
Articolo 101598- Novembre 2021 Ritorno al numero
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