The optimal cut-off for predicting large oesophageal varices using transient elastography is disease specific

Area of Science:

• Hepatology
• Gastroenterology
• Medical Diagnostics

Background:

• Esophageal varices screening is crucial for cirrhosis diagnosis, often requiring upper gastrointestinal endoscopy.
• Non-invasive methods like elastography are increasingly used to diagnose cirrhosis, potentially replacing liver biopsy.
• Identifying large esophageal varices (F2) is critical for managing cirrhosis complications.

Purpose of the Study:

• To determine an optimal liver stiffness cut-off for predicting large esophageal varices (>F2).
• To assess if this liver stiffness cut-off is disease-specific for predicting esophageal varices.
• To compare the diagnostic accuracy of liver stiffness with platelet count for varices prediction.

Main Methods:

• Two hundred and twenty-two patients with all-cause cirrhosis (Child class A) were screened.
• Two hundred and eleven patients underwent successful elastography for liver stiffness measurement.
• Receiver Operating Characteristic (ROC) curve analysis was used to determine the optimal cut-off and diagnostic accuracy.

Main Results:

• A liver stiffness cut-off of 19.8 kPa demonstrated a 91% negative predictive value and 55% positive predictive value for large varices (AUC 0.73).
• In patients with hepatitis C, this cut-off showed a 98% negative predictive value, misclassifying only one patient.
• Liver stiffness measurement was more accurate than platelet count in diagnosing esophageal varices across all patients.

Conclusions:

• A liver stiffness of >19.8 kPa can serve as a valuable cut-off for initiating endoscopy and beta-blocker therapy in cirrhosis patients.
• This cut-off is particularly effective in patients with hepatitis C, improving the non-invasive prediction of large esophageal varices.
• Liver stiffness measurement offers a superior, non-invasive alternative to platelet count for predicting esophageal varices in cirrhosis.