Validation of the Combined Model Based on Platelet Count and Albumin to Rule out High-Risk Varices in Liver Cirrhosis

Abstract

Background. The Baveno VI criteria based on platelet count and liver stiffness, measured by transient elastography (TE), have been proposed to rule out high-risk varices (HRV) defined as medium or large-sized varices or the presence of high-risk stigmata (cherry red spots and red wale marks). However, TE is not available in all hospitals. Recently, the Rete Sicilia Selezione Terapia hepatitis C virus (RESIST-HCV) criteria recommended that cirrhotic patients with a platelet count>120000/μL and serum albumin>36 g/L could avoid esophagogastroduodenoscopy (EGD) screening for HRV. Aim. We aimed to validate the performance of the RESIST-HCV criteria in two cohorts predominantly characterized with hepatitis B infection. Methods. Patients with compensated cirrhosis who had blood tests within three months of performing EGD and TE were enrolled retrospectively from two centers. RESIST-HCV criteria were applied to identify patients who did not require EGD screening. Results. This study included 188 patients from the Xingtai cohort (28 (14.9%) with HRV) and 104 patients from the Beijing cohort (19 (18.3%) with HRV). Of the patients who met the RESIST-HCV criteria (83 in the Xingtai cohort and 26 in the Beijing cohort), 0 and 1 had HRV, respectively, accounting for 44.1% (Xingtai cohort) and 25% (Beijing cohort) of endoscopies that were unnecessary. In the combined cohort, 109 (37.3%) patients met the RESIST-HCV criteria, only 1 (0.9%) HRV was missed, and the negative predictive value was 99.1%. Baveno VI and Expanded Baveno VI criteria spared 15.6% and 23.3% of EGDs, respectively, while missing 0% and 4.8% of HRV, respectively. Conclusions. In our population, the combined criteria based on platelet count and serum albumin performed well, saving 30-40% of EGDs and correctly identifying 99.1% of patients who could safely avoid screening endoscopies for high-risk varices in compensated cirrhotic patients.

RESIST-HCV Criteria to Monitor Progression of Low-Risk Esophageal Varices in Patients With Compensated Cirrhosis After HCV Eradication: The SIMPLE Study

“…These criteria have been validated in patients with active hepatitis C virus (HCV) or HBV infection (8) and in patients with nonalcoholic fatty liver disease (9), and they are limited by the use of transient elastography (TE), a tool that could not be available in nonreferral centers and in low-resource countries. We previously demonstrated that Rete Sicilia Selezione Terapia HCV (RESIST-HCV) biochemical-based criteria, including only platelet count and serum albumin, assessed before direct-acting antiviral agents (DAAs), showed a similar accuracy to that of elastography-based criteria for predicting the presence of HRV (10)(11)(12). It is important to take into account that all noninvasive criteria for HRV prediction have been evaluated in patients with HCV with compensated advanced chronic liver disease before DAAs alone.…”

Noninvasive assessment oesophageal varices: impact of the Baveno VI criteria

“…These are much less validated than Baveno VI criteria. The RESIST-HCV criteria were specifically developed for hepatitis-C related cirrhosis and proposed a combination of platelet count more than 120000 cells/ml and serum albumin more than 3.6 g/dL [10,12]. However, with increasing HRV prevalence, as shown in the study by Sharma et al [25], and similar to what occurs with the expanded Baveno VI criteria, the NPV decreases to below 95%.…”

“…Indeed, the term ‘compensated advanced chronic liver disease’ (cACLD) was coined to reflect the continuum of severe fibrosis and cirrhosis in patients with ongoing chronic liver disease [5]. Doing a gastroscopy in all patients with cACLD would result in unnecessary load to endoscopy services, and would be low yield, as the prevalence of high-risk varices in these patients is around 10–15% (Table 1) [6–29,30 ▪▪ ,31,32 ▪▪ ,33].…”

Hypergammaglobulinemia before Starting DAA Therapy Is A Strong Predictor of Disease Progression in Cirrhotic Patients Even after HCV Clearance

“…Finally, we also stratified the patients on the basis of resisting HCV scores [RESIST-HCV low risk (LR) if they had PLT count >120,000/L and serum albumin 3.6 g/dL or RESIST-HCV high risk (HR) if they had PLT count <120,000/L or serum albumin <3.6 g/dL] to Monitor Progression of Esophageal Varices [30][31][32].…”