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Development and Validation of an Easy-to-Use Risk Scoring System for Screening High-Risk Varices in Patients with

Yuling Yan1,2, Xian Xing1,2, Xiaoze Wang1,2

  • 1Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.

Digestive Diseases and Sciences
|January 12, 2021
PubMed

Insights

A new scoring system, the albumin-platelet-portal vein diameter (APP) score, can safely identify patients with hepatitis B virus-related compensated advanced chronic liver disease (cACLD) who do not need an esophagogastroduodenoscopy (EGD). This tool helps avoid unnecessary procedures for many patients with cACLD.

Area of Science:

  • Hepatology
  • Gastroenterology
  • Medical Diagnostics

Background:

  • Many patients with compensated advanced chronic liver disease (cACLD) do not have or have low-risk esophageal varices.
  • Esophagogastroduodenoscopy (EGD) is commonly used to screen for esophageal varices, but it is invasive and may not be necessary for all patients.

Purpose of the Study:

  • To develop and validate a simple risk scoring system to identify high-risk varices (HRV) in patients with hepatitis B virus (HBV)-related cACLD.
  • To enable the avoidance of EGD in patients with cACLD who have a low risk of HRV.

Main Methods:

  • A total of 334 patients with HBV-related cACLD underwent laboratory tests and ultrasound.
  • Multivariate logistic regression identified independent risk factors for HRV.
  • A scoring system, the albumin-platelet-portal vein diameter (APP) score, was created and validated in training and validation cohorts.

Main Results:

  • The APP score identified independent risk factors for HRV: albumin, platelet count, and portal vein diameter.
  • A negative predictive value exceeding 95% for HRV was achieved with an APP score < 0.24.
  • In the validation cohort, only 1.7% of patients with an APP score < 0.24 had HRV, indicating high safety.

Conclusions:

  • The APP score is a promising tool for safely screening for HRV in patients with HBV-related cACLD.
  • This scoring system has the potential to reduce the need for EGD in this patient population.
Abstract

Keywords:
Esophageal varicesEsophagogastroduodenoscopyLiver cirrhosisPlatelet count

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