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Spleen Thickness Plus Platelets Can Effectively and Safely Screen for High-Risk Varices in Cirrhosis Patients

Fengbin Zhang1,2, Yonghe Zhou3, Xin Li3

  • 1Clinical School of the Second People's Hospital, Tianjin Medical University, Tianjin 300070, China.

Diagnostics (Basel, Switzerland)
|October 28, 2023
PubMed

Insights

Spleen thickness and platelet count offer a convenient alternative to standard methods for screening high-risk varices in cirrhosis patients, potentially reducing the need for invasive procedures.

Area of Science:

  • Hepatology
  • Medical Imaging
  • Gastroenterology

Background:

  • Guidelines recommend liver and spleen stiffness measurements to exclude high-risk varices (HRVs) in cirrhosis patients.
  • Routine performance of these stiffness measurements is not feasible in most primary hospitals.
  • There is a need for more accessible indicators for HRV screening.

Purpose of the Study:

  • To identify convenient indicators for screening high-risk varices (HRVs) in cirrhosis patients.
  • To evaluate the efficacy of spleen thickness (ST) and platelet count (PLT) as predictors for HRVs.
  • To compare the performance of ST+PLT with existing criteria like Baveno VI and spleen stiffness measurements (SSMs).

Main Methods:

  • A training cohort (TC) of 213 cirrhosis patients and a validation cohort (VC) of 65 primary biliary cirrhosis patients were enrolled.
  • Indicators including spleen stiffness measurements (SSMs), liver stiffness measurements (LSMs), spleen thickness (ST), and platelet count (PLT) were analyzed.
  • The ability of ST+PLT to spare esophagogastroduodenoscopies (EGDs) while detecting HRVs was assessed and compared to Baveno VI and SSM+PLT.

Main Results:

  • Spleen thickness (ST) and platelet count (PLT) were identified as independent risk indicators for HRVs.
  • In the training cohort, ST+PLT avoided 35.7% of EGDs with a 2.4% missed HRV rate, outperforming Baveno VI criteria.
  • In the validation cohort, ST+PLT safely spared 24.6% of EGDs, similar to Baveno VI criteria.

Conclusions:

  • The combination of spleen thickness and platelet count (ST+PLT) is a viable and convenient model for excluding high-risk varices when spleen stiffness measurements are not routinely available.
  • ST+PLT demonstrates superior performance to Baveno VI criteria in excluding HRVs but is slightly less effective than SSM+PLT.
  • This model offers a practical alternative for reducing unnecessary esophagogastroduodenoscopies in cirrhosis patients.

Keywords:
2D-SWEhigh-risk varicesliver stiffness measurementprimary biliary cirrhosisspleen stiffness measurementspleen thickness

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