Predicting Esophageal Varices and Varices Needing Treatment in Compensated Advanced Chronic Liver Disease

Many noninvasive scoring systems have been proposed to identify patients with compensated advanced chronic liver disease (cACLD). However, these scores have not been compared for their accuracy in predicting clinically significant portal hypertension (CSPH). We compared head-to-head the accuracy of recently described noninvasive scores for predicting CSPH (esophageal varices [EV] and varices needing treatment [VNT]) in patients with cACLD.

We compared the ability of Baveno VI criteria (BC), expanded BC (EBC), aspartate transaminase platelet count ratio index, MELD-Na, liver stiffness measurement, fibrosis (FIB)-4 score, CHESS-ALARM score, and FIB-5 score to predict the presence of EV and VNT in a cohort of patients with cACLD.

BC and EBC correctly identified patients with EV, gastric varices (GV), and VNT. BC spared esophagogastroduodenoscopy (EGD) in 48% of patients, with 6.4% miss rate for EV; EBC spared EGD in 60% of patients, with 0% miss rate for VNT. The miss rates of EV resulting from BC were similar between groups with or without metabolic dysfunction-associated steatotic liver disease (MASLD) and between obese and nonobese MASLD groups. BC (p < 0.001), EBC (p < 0.001), CHESS-ALARM score (p < 0.001, cut off > 0.37), and FIB-5 score (p < 0.001, cut off > 0.75) independently predicted EV and VNT.

BC and EBC could spare EGD in patients with cACLD, with low miss rates for EV, GV, and VNT. Their performance was similar for the MASLD and non-MASLD groups. CHESS-ALARM score and FIB-5 score are highly accurate for predicting CSPH (EV and VNT) in patients with cACLD.