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Prediction of High-Risk Varices in Patients with Compensated Advanced Chronic Liver Disease in Saudi Arabia
Mona Ismail1,2
1Division of Gastroenterology, Department of Internal Medicine, King Fahd Hospital of the University, Alkhobar, Saudi Arabia.
Insights
The Baveno VI criteria effectively screen for high-risk varices in Saudi Arabian patients with compensated advanced chronic liver disease (cACLD), reducing the need for endoscopy. These criteria help identify patients needing treatment while avoiding unnecessary procedures.
Area of Science:
- Hepatology
- Gastroenterology
- Medical Diagnostics
Background:
- Compensated advanced chronic liver disease (cACLD) carries a risk of portal hypertension and high-risk varices (HRVs).
- Screening endoscopy is crucial for managing HRVs but may not be necessary for all cACLD patients.
- Limited data exists on the validation of Baveno VI criteria in Saudi Arabia.
Purpose of the Study:
- To validate the Baveno VI and expanded Baveno VI criteria for screening endoscopy in Saudi Arabian patients with cACLD.
- To identify risk factors associated with HRVs in this population.
Main Methods:
- Analysis of data from 215 cACLD patients diagnosed via transient elastography (LSM > 10 kPa).
- Paired platelet count and screening upper endoscopy data were collected within one year of diagnosis.
- Sensitivity, specificity, and ROC curves were calculated; logistic regression identified HRV risk factors.
Main Results:
- Baveno VI criteria spared 50.7% of endoscopies, missing 3.7% of varices needing treatment (VNTs).
- Expanded Baveno VI criteria spared 63.7% of endoscopies, missing 5.1% VNTs.
- Platelet count and liver stiffness measurement (LSM) were identified as predictors of HRV.
Conclusions:
- The Baveno VI criteria are effective in identifying HRVs in Saudi Arabian cACLD patients, reducing unnecessary endoscopies.
- While expanded criteria avoid more procedures, they increase the risk of missed HRVs.
- Platelet count and LSM are significant predictors for HRV in this cohort.
Purpose:
Liver stiffness and low platelet count can predict portal hypertension and high-risk varices (HRVs) in patients with cirrhosis. Thus, screening endoscopy may not be required for all patients with compensated advanced chronic liver disease (cACLD). However, data from Saudi Arabia are limited. This study aimed to validate the Baveno VI and expanded Baveno VI criteria for screening endoscopy and identify the risk factors associated with HRVs in patients with cACLD in Saudi Arabia.
Patients And Methods:
We analyzed data from 215 patients with cACLD diagnosed on transient elastography (LSM > 10 kPa) and had paired platelet count and screening upper endoscopy performed within one year of diagnosis. HRVs or varices needing treatment (VNTs) were defined as medium-to-large esophageal varices (EVs), small EVs with red flags, or gastric varices. Sensitivity, specificity, and area under the receiver operating characteristic curve were calculated. Univariate and multivariate logistic regression analyses identified HRV risk factors.
Results:
The Baveno VI criteria spared 50.7% of endoscopies, missing 3.7% of VNTs, while the expanded Baveno VI criteria spared 63.7% of endoscopies, missing 5.1% VNTs. An LSM <20 kPa and platelet count > 150,000/µL were associated with HRV in 8.1% and 8.3%, respectively. While an LSM <25 kPa and platelet count > 110,000/µL were associated with HRV in 9.7% and 9%, respectively. The Baveno VI criteria had sensitivity and specificity of 76% and 55%, while the expanded criteria had 67% and 69%, respectively. Baveno VI criteria performed better in hepatitis C virus patients than nonalcoholic fatty liver disease patients. Multivariate logistic regression analysis revealed platelet count and LSM as predictors of HRV.
Conclusion:
The Baveno VI criteria effectively identified HRVs in cACLD patients from Saudi Arabia, reducing unnecessary endoscopies. Although the expanded criteria avoided more endoscopies, it led to a higher rate of missed HRVs.
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