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Spleen Stiffness-Based Algorithms Are Superior to Baveno VI Criteria to Rule Out Varices Needing Treatment in
Emma Vanderschueren1,2, Angelo Armandi3,4, Wilhelmus Kwanten5,6
1Department of Gastroenterology and Hepatology, University Hospital Leuven, Leuven, Belgium.
Insights
Spleen stiffness measurement (SSM) algorithms significantly improve the detection of varices needing treatment (VNT) in advanced chronic liver disease (ACLD) patients. These novel methods double the number of patients who can safely avoid screening endoscopy compared to current Baveno VI criteria.
Area of Science:
- Hepatology
- Medical Imaging
- Noninvasive Diagnostics
Background:
- Compensated advanced chronic liver disease (ACLD) management relies on Baveno VI criteria for noninvasive assessment.
- Current Baveno VI criteria, combining liver stiffness measurement (LSM) and platelet count, identify a limited number of patients eligible to avoid screening endoscopy for varices needing treatment (VNT).
Purpose of the Study:
- To evaluate the efficacy of spleen stiffness measurement (SSM) using spleen-dedicated elastography in ruling out VNT in ACLD patients.
- To compare SSM-based algorithms against the established Baveno VI criteria for identifying patients who can avoid endoscopy.
Main Methods:
- A multicenter retrospective cohort study included ACLD patients with available LSM, platelet count, spleen diameter, and SSM data.
- Varices needing treatment (VNT) were defined as medium-to-large varices or small varices with red spots.
- Derivation and validation cohorts were used to assess the performance of SSM-based algorithms.
Main Results:
- SSM demonstrated superior capability in identifying VNT compared to LSM and platelet count (AUROC 0.88 vs. 0.77 and 0.73, respectively).
- Sequential Baveno VI plus SSM and a novel spleen size and stiffness model increased the proportion of patients avoiding endoscopy from 33.8% (Baveno VI) to 66.2% and 71.1%, respectively.
- In a validation cohort, SSM-based algorithms tripled the number of spared endoscopies (27.3% and 31.3%) compared to Baveno VI criteria (8.5%).
Conclusions:
- Spleen stiffness-based algorithms are more effective than Baveno VI criteria for ruling out VNT in ACLD patients.
- These SSM-based approaches significantly increase the number of patients who can avoid screening endoscopy without compromising safety.
- Spleen elastography offers a promising noninvasive tool for managing ACLD and optimizing screening strategies.
Introduction:
The Baveno VI criteria have set the stage for noninvasive assessment of compensated advanced chronic liver disease (ACLD). The algorithm combining liver stiffness measurement (LSM, <20 kPa) and platelet count (>150,000/μL) safely avoids screening endoscopy for varices needing treatment (VNT) but identifies only a relatively low number of patients. We aimed to evaluate the value of spleen stiffness measurement (SSM) using spleen-dedicated elastography in ruling out VNT.
Methods:
In this real-life multicenter retrospective derivation-validation cohort, all consecutive patients with ACLD (defined by LSM ≥10 kPa) with available upper endoscopy, laboratory results, spleen diameter, LSM, and SSM measured with spleen-dedicated transient elastography were included. VNT were defined as medium-to-large varices or small varices with red spots.
Results:
In the derivation cohort (n = 201, 11.9% VNT), SSM demonstrated excellent capability at identifying VNT (area under the receiver operating characteristic curve [AUROC] 0.88), outperforming LSM (AUROC 0.77, P = 0.03) and platelets (AUROC 0.73, P = 0.002). In comparison with Baveno VI criteria (33.8% spared endoscopies), the sequential Baveno VI plus SSM and a novel spleen size and stiffness model were able to increase the number of patients avoiding endoscopy (66.2% and 71.1%, respectively) without missing more than 5% of VNT. These findings were confirmed in an external validation cohort of patients with more advanced liver disease (n = 176, 34.7% VNT) in which the number of spared endoscopies tripled (27.3% and 31.3% for SSM-based algorithms) compared with Baveno VI criteria (8.5%).
Discussion:
Spleen stiffness-based algorithms are superior to Baveno VI criteria in ruling out VNT in patients with ACLD and double the number of patients avoiding screening endoscopy.
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