Combination of albumin-bilirubin grade and platelets to predict a compensated patient with hepatocellular carcinoma who does not require endoscopic screening for esophageal varices

Chen, Ping‐Hsien; Hsieh, W.-Y.; Su, Chien–Wei; Hou, Ming‐Chih; Wang, Yen‐Po; Hsin, I-Fang; Yang, Tsung-Chieh; Liao, Wei‐Chih; H, Lin; Lee, Fa-Yauh; Wu, Jaw–Ching

doi:10.1016/j.gie.2017.12.023

Cited by 29 publications

(28 citation statements)

References 37 publications

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“…Schwarzenberger et al in their study reported various parameters like ascites, splenomegaly, serum albumin concentration, Child score, and portal vein diameter as predictive variables for LEVx (30). Recently, Chen et al evaluated the combined effect of "albumin bilirubin grade and platelet count" to predict risk of large varices and variceal haemorrhage (5). Due to the diversity of liver diseases and variations in the characteristics among different populations earlier studies have shown different parameters to predict large esophageal varices.…”

Section: Discussionmentioning

confidence: 99%

“…Esophageal varices are a big challenge in managing cirrhotic patients and suggest its early detection with either invasive or non-invasive methods. (1) Various studies have evaluated the non-invasive predicting markers for large esophageal varices (LEVx) (2)(3)(4)(5). Advanced Child-Pugh score, platelet count, serum albumin level, splenomegaly and increase portal vein diameter at ultrasonography are reported by several studies as the possible useful markers (6)(7)(8).It is stated that due to the disparities in the etiology and severity of liver cirrhosis and because of the nutritional status differences, these non-invasive prognostic factors showed variations when studied in different populations (8).…”

Section: Introductionmentioning

confidence: 99%

“…Consequently, LEVx screening not only generates a huge burden on endoscopic units but is also a financial constraint on liver cirrhotics. Keeping the social, financial, and healthcare resource burdens implicated by these recommendations, recent studies have focused on the utility of non-invasive approaches to identify patients with LEVx, thereby, preventing the endoscopy of patients with lower risk (3)(4)(5)8).…”

Section: Introductionmentioning

confidence: 99%

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Non-invasive assessment of large esophageal varices with liver cirrhosis ; a study conducted in Pakistan

et al. 2019

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The assessment of non-invasive parameters for the prediction of large esophageal varices among patients with liver cirrhosisis is of utmost importance. In this study, non-invasive parameters for prediction of large esophageal varices were retrospectively evaluated. The presence of esophageal varices grade III and IV was classified as large esophageal varices positive while no varices or grade I and II were classified as large esophageal varices negative. There were 473 (90.09%) patients with ascites [mild 38 (8.03%), moderate 257 (54.33%) and severe 178 (37.63%)]. Frequency of esophageal varices was found to be higher (n=415, 79.04%). Whereas, large esophageal varices were found in 251 (47.81%) patients. The sensitivity, specificity, positive predicted value, negative predicted value and test accuracy of thrombocytopenia in predicting large esophageal varices were found to be 88.05%, 59.85%, 66.77%, 84.54% and 73.33% respectively. A significant association for large esophageal varices was observed for low platelet counts (AOR : 0.98, 95% CI : 0.97-0.99), high bilirubin level (AOR : 1.22, 95% CI : 1.07-1.39), ascites (AOR : 1.98, CI : 1.02-3.85) and Child score A (AOR : 0.26, 95% CI : 0.09-0.75) and Child Score B (AOR : 0.42, 95% CI : 0.28-0.61). In conclusion, low platelet count, high bilirubin level and ascites are found to be non-invasive predictive factor for large esophageal varices. J. Med. Invest. 66 : 248-251, August, 2019

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Non-invasive assessment of large esophageal varices with liver cirrhosis ; a study conducted in Pakistan

et al. 2019

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“…ALBI, [7] PALBI [8] and ALBI-PLT [9] are models for assessment of the liver condition without subjective bias. They are based on routine simple investigations.…”

Section: Discussionmentioning

confidence: 99%

“…MHE was diagnosed using the critical flicker frequency [6], number connection test and serial dotting test [5]. ALBI-PLT [9] = sum of the ALBI grade (I-III) to the platelet count grade (I-II). Grade I platelet count = platelets > 150,000/mm 3 and Grade II platelet count = platelets ≤ 150,000/mm 3 .…”

Section: Methodsmentioning

confidence: 99%

Prediction of minimal encephalopathy in patients with HCV-related cirrhosis using albumin-bilirubin, platelets-albumin-bilirubin score, albumin-bilirubin-platelets grade and ammonia level

Alsebaey

2020

Egypt Liver Journal

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Background: Minimal hepatic encephalopathy (MHE) is a complication of liver cirrhosis causing low quality of life, driving skills and higher traffic violation. The neuro-psychometric tests are the gold standard but difficult clinically and time-consuming. The aim was to assess albumin-bilirubin (ALBI), platelets-albumin-bilirubin (PALBI) score, albumin-bilirubin-platelets (ALBI-PLT) grade and ammonia level as MHE predictors. All the patients (n = 257) underwent critical flicker frequency number connection, serial dotting and digit symbol test for MHE diagnosis (n = 166, 64.6%). Liver function, INR, CBC and arterial ammonia were measured. Results: There was statistically significant difference (p < 0.05) between MHE patients and those without as regards ammonia (86.59 ± 23.25 vs. 63.56 ± 24.2 μmol/L), ALBI score (−2.13 ± 0.53 vs. −2.49 ± 0.38), PALBI score (−2.33 ± 0.39 vs. −2.55 ± 0.26) and ALBI-PLT (3.98 ± 0.49 vs. 3.70 ± 0.56). Patients with MHE were mainly Child-Pugh B and C and also ALBI grade 2 and 3. For MHE discrimination, ALBI, PALBI, ALBI-PLT and ammonia had the following cutoffs >−2.36 (57.23% sensitivity, 77.78% specificity), >−2.5 (60.84% sensitivity, 67.9% specificity), > 3 (87.35% sensitivity, 27.16% specificity) and > 76.5 (69% sensitivity, 72.5% specificity) respectively (p = 0.001). On comparison of the area under the curve, ALBI is comparable to PALBI (p = 0.245) and ammonia (p = 0.603). The ALBI-PLT is inferior to ALBI (p = 0.018) and ammonia (p = 0.021) but comparable to PALBI (p = 0.281). ALBI (odds = 5.64), PALBI (odds = 7.86), ALBI-PLT (odds = 2.86), ammonia (odds = 1.05), Child-Pugh score (odds = 2.13), MELD (odds = 1.26) are independent predictors of MHE. Conclusion: ALBI, PALBI and ammonia are clinical useful model for MHE prediction.

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Risk of variceal hemorrhage and pretransplant mortality in children with biliary atresia

Bass

Hawthorne

et al. 2022

Hepatology

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Background and Aims The natural history of gastroesophageal variceal hemorrhage (VH) in biliary atresia (BA) is not well characterized. We analyzed risk factors, incidence, and outcomes of VH in a longitudinal multicenter study. Approach and Results Participants enrolled in either an incident (Prospective Database of Infants with Cholestasis [PROBE]) or prevalent (Biliary Atresia Study of Infants and Children [BASIC]) cohort of BA were included. Variceal hemorrhage (VH) was defined based on gastrointestinal bleeding in the presence of varices accompanied by endoscopic or nontransplant surgical intervention. Cumulative incidence of VH and transplant‐free survival was compared based on features of portal hypertension (e.g., splenomegaly, thrombocytopenia) and clinical parameters at baseline in each cohort (PROBE: 1.5 to 4.5 months after hepatoportoenterostomy [HPE]; BASIC: at enrollment > 3 years of age). Analyses were conducted on 869 children with BA enrolled between June 2004 and December 2020 (521 in PROBE [262 (51%) with a functioning HPE] and 348 in BASIC). The overall incidence of first observed VH at 5 years was 9.4% (95% CI: 7.0–12.4) in PROBE and 8.0% (5.2–11.5) in BASIC. Features of portal hypertension, platelet count, total bilirubin, aspartate aminotransferase (AST), albumin, and AST‐to‐platelet ratio index at baseline were associated with an increased risk of subsequent VH in both cohorts. Transplant‐free survival at 5 years was 45.1% (40.5–49.6) in PROBE and 79.2% (74.1–83.4) in BASIC. Two (2.5%) of 80 participants who had VH died, whereas 10 (12.5%) underwent transplant within 6 weeks of VH. Conclusions The low risk of VH and associated mortality in children with BA needs to be considered in decisions related to screening for varices and primary prophylaxis of VH.

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Combination of albumin-bilirubin grade and platelets to predict a compensated patient with hepatocellular carcinoma who does not require endoscopic screening for esophageal varices

Cited by 29 publications

References 37 publications

Non-invasive assessment of large esophageal varices with liver cirrhosis ; a study conducted in Pakistan

Non-invasive assessment of large esophageal varices with liver cirrhosis ; a study conducted in Pakistan

Prediction of minimal encephalopathy in patients with HCV-related cirrhosis using albumin-bilirubin, platelets-albumin-bilirubin score, albumin-bilirubin-platelets grade and ammonia level

Risk of variceal hemorrhage and pretransplant mortality in children with biliary atresia

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