Platelet count, spleen length, and platelet count-to-spleen length ratio for the diagnosis of oesophageal varices in people with chronic liver disease or portal vein thrombosis

Colli, Agostino; Gana, Juan Cristóbal; Yap, Jason; Adams‐Webber, Thomasin; Rashkovan, Natalie; Ling, Simon C.; Casazza, Giovanni

doi:10.1002/14651858.cd008759.pub2

Cited by 49 publications

(56 citation statements)

References 126 publications

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“…One of the major limitations of these criteria, however, is their inapplicability when liver stiffness cannot be assessed for technical reasons, or when its measurement is unreliable, figures that in large cohorts of patients are observed in 3.1% and 15.8% of examinations, respectively, and that may jeopardise its accuracy when—due to these limitations—stiffness measurement cannot be applied to the whole population under evaluation 26,27 . On the other hand, the PLT/SDR has been validated in several, independent series of patients within a wide spectrum of disease severity and aetiology globally, and its diagnostic accuracy has been supported by at least two meta‐analyses, a systematic review and a Cochrane collaboration technical review 28‐37 …”

Section: Discussionmentioning

confidence: 99%

Course of oesophageal varices and performance of noninvasive predictors following Hepatitis C Virus clearance in compensated advanced chronic liver disease

Giannini

Maria

Crespi

et al. 2020

Eur J Clin Investigation

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Background:In patients with hepatitis C virus (HCV) and compensated advanced chronic liver disease (cACLD), there is evidence that sustained virological response (SVR) to direct-acting antivirals (DAA) may ameliorate portal hypertension, although both the course of oesophageal varices and the performance of their noninvasive predictors following DAA-induced SVR are less defined. In this study, our aim was to assess the variation in oesophageal varices status in HCV patients with cACLD who obtained an SVR to DAAs and to evaluate the diagnostic performance of noninvasive predictors of varices after HCV cure. Material and methods: Sixty-three HCV patients with cACLD and SVR to DAAs were prospectively followed up, and oesophageal varices surveillance was carried out according to the Baveno VI indications. Appearance and disappearance of varices, accuracy performance of their noninvasive predictors (Baveno/expanded Baveno VI criteria, platelet count/spleen diameter ratio) and number of endoscopies spared with their application were calculated. Results: Following SVR, varices developed or disappeared in 12.1% and 17.4% of patients, respectively. The negative predictive value for varices of the Baveno VI, expanded Baveno VI criteria and platelet count/spleen diameter ratio following SVR was 88.2% (65.6-96.7), 83.3% (66.3-92.7) and 80.7% (67.1-89.5), respectively.Their application would have saved 30.4%, 42.9% and 55.4% of endoscopies, with no varices needing treatment missed using both Baveno VI criteria. Conclusions: In HCV patients with cACLD, following SVR to DAA, the expanded Baveno VI criteria provide the best balance between utility (diagnostic accuracy and endoscopies avoided) and safety (varices needing treatment missed) for varices surveillance. K E Y W O R D Scirrhosis, liver stiffness, platelet count/spleen diameter ratio, portal hypertension 2 of 10 | GIANNINI et Al.

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Section: Discussionmentioning

confidence: 99%

Course of oesophageal varices and performance of noninvasive predictors following Hepatitis C Virus clearance in compensated advanced chronic liver disease

Giannini

Maria

Crespi

et al. 2020

Eur J Clin Investigation

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“…Utilisation of better technologies to stratify for cirrhosis and OV including non‐invasive markers and MRI may have a future role . More recently non‐invasive tools such as Baveno criteria, liver stiffness to spleen/platelet score and platelet‐spleen ratio score have been validated as good negative markers to predict the absence of OV. Such non‐invasive tests may help minimise the subjective nature of human classification systems and reduce the overall work‐load of variceal screening endoscopy.…”

Section: Discussionmentioning

confidence: 99%

“…Whether or not there is a 'glass ceiling' with subjective human classification systems, ie possibly no classification system will im- and platelet-spleen ratio score 24 have been validated as good negative markers to predict the absence of OV. Such non-invasive tests may help minimise the subjective nature of human classification systems and reduce the overall work-load of variceal screening endoscopy.…”

Section: Discussionmentioning

confidence: 99%

Validation of the AASLD recommendations for classification of oesophageal varices in clinical practice

Fateen

Ragunath

White

et al. 2019

Liver International

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Background & Aims The American Association for the Study of Liver Diseases recommends the use of a 2‐grade classification system (small and large) to describe the size of oesophageal varices (OV). Data on observer agreement (OA) on this system are currently lacking. We aimed to evaluate this classification and compare it to the widely used 3‐grade classification (grade 1 ‘small’, grade 2 ‘medium’, grade 3 ‘large’) among operators of variable experience. Methods High‐definition video recordings of 100 patients with cirrhosis were prospectively collected using standardised criteria. Nine observers of variable experience performed independent evaluations of the videos in random order. OV were scored using both systems. All assessments were repeated a year later by the same observers to assess intra‐observer agreement. Results Interobserver agreement (all observers) using the 2‐grade and the 3‐grade system was k = 0.71 (95% CI: 0.64‐0.78) and k = 0.73 (95% CI: 0.66‐0.79) respectively. When using the 2‐grade system, intra‐observer agreement between hepatologists (n = 3), luminal gastroenterologists (n = 3) and trainee gastroenterologists (n = 3) was k = 0.89 (95% CI: 0.86‐0.91), k = 0.72 (95% CI: 0.67‐0.77), and k = 0.74 (95% CI: 0.67‐0.8) respectively. With the 3‐grade system; intra‐observer agreement between the same three subgroups were k = 0.9 (95% CI: 0.87‐0.92), k = 0.73 (95% CI: 0.68‐0.78), k = 0.77 (95% CI: 0.71‐0.82) respectively. Conclusions There was no difference in OA between the 2‐grade and 3‐grade classification systems. Hepatologists had significantly higher levels of consistency in grading OV. This may have implications to create alternative training models for residents and fellows in the recognition and grading of OV.

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“…These scoring systems rely on a combination of platelet count, liver enzymes, albumin, and spleen size. A 2017 review states that the platelet count–to‐spleen ratio is the most accurate predictor in adults . In pediatric patients, the British Society of Paedatric Gastroenterology, Hepatology, and Nutrition endorsed that a platelet count of <120 × 10 9 /L should lead to surveillance .…”

Section: Diagnosis Management and Treatment Of Liver Disease In Cfmentioning

confidence: 99%

“…A 2017 review states that the platelet count-to-spleen ratio is the most accurate predictor in adults. (37) In pediatric patients, the British Society of Paedatric Gastroenterology, Hepatology, and Nutrition endorsed that a platelet count of <120 × 10 9 /L should lead to surveillance. (38,39) More recent studies using transient elastography have also demonstrated accuracy in identifying those individuals at greatest risk for portal hypertension.…”

Section: Cirrhosis and Portal Hypertensionmentioning

confidence: 99%

Cystic Fibrosis–Associated Liver Disease in Lung Transplant Recipients

Mallea¹,

Bolan²,

Cortese

et al. 2019

Liver Transpl

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Cystic fibrosis (CF) is an autosomal recessive disease characterized by mutations in the gene that encodes for the cystic fibrosis transmembrane conductance regulator protein (CFTR). CFTR gene mutations manifest as epithelial cell dysfunction in the airways, biliary tract, pancreas, gut, sweat glands, paranasal sinuses, and genitourinary tract. The clinical manifestations of this dysfunction include respiratory tract infections, bronchiectasis, pancreatic insufficiency, malabsorption, intestinal obstruction, liver disease, and male infertility. The liver disease manifestations of CF can include biliary disease, multilobular cirrhosis, and portal hypertension with and without cirrhosis. Pulmonary disease is the main cause for morbidity and mortality in individuals with CF, and according to the International Society for Heart and Lung Transplantation, CF is the third most common indication for lung transplantation in adults, accounting for 16% of procedures performed. The survival after lung transplantation in individuals with CF continues to improve and is now the highest among end‐stage lung diseases requiring transplant. The survival rate at 10 years is close to 50%. Given the potential presence of liver disease in CF patients undergoing an evaluation for lung transplantation and in lung transplant recipients, it is important to understand the manifestations of liver disease in CF patients and the recommended workup and follow‐up. This review aims to discuss the current literature and provide guidance in the management of these patients.

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Platelet count, spleen length, and platelet count-to-spleen length ratio for the diagnosis of oesophageal varices in people with chronic liver disease or portal vein thrombosis

Abstract: Platelet count, spleen length, and platelet count-to-spleen length ratio for the diagnosis of oesophageal varices in people with chronic liver disease or portal vein thrombosis.

Cited by 49 publications

References 126 publications

Course of oesophageal varices and performance of noninvasive predictors following Hepatitis C Virus clearance in compensated advanced chronic liver disease

Course of oesophageal varices and performance of noninvasive predictors following Hepatitis C Virus clearance in compensated advanced chronic liver disease

Validation of the AASLD recommendations for classification of oesophageal varices in clinical practice

Cystic Fibrosis–Associated Liver Disease in Lung Transplant Recipients

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