Screening varices in patients with HBV-related cirrhosis on antiviral therapy: Platelet alone or together with LSM
Bingqiong Wang 1 , Jialing Zhou 1 , Xiaoning Wu 1 , Yameng Sun 1 , Lei Li 2 , Ping Li 3 , Minghui Li 4 , Wei Jiang 5 , Mingyi Xu 6 , Bo Feng 7 , Xiaoyuan Xu 8 , Jilin Cheng 9 , Wen Xie 4 , Tao Han 10 , Xiaozhong Wang 11 , Hai Li 12 , Hongxin Piao 13 , Shanshan Wu 1 , Yiwen Shi 1 , Shuyan Chen 1 , Yuanyuan Kong 1 , Hong Ma 1 , Xiaojuan Ou 1 , Jidong Jia 1 , Hong You 1
Affiliations
Affiliations
1
Liver Research Center, Beijing Friendship Hospital, Capital Medical University, BeijingKey Laboratory of Translational Medicine on Liver Cirrhosis, National Clinical Research Center for Digestive Diseases, Beijing, China.
2
Department of Gastroenterology and Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, China.
3
Department of Hepatology, Tianjin Second People's Hospital, Tianjin, China.
4
Liver Disease Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
5
Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai, China.
6
Department of Gastroenterology and Hepatology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
7
Hepatology Institute, Peking University People's Hospital, Beijing, China.
8
Department of Infectious Disease, Peking University First Hospital, Beijing, China.
9
Department of Gastroenterology, Shanghai Public Health Clinical Center, Shanghai, China.
10
Department of Hepatology, Tianjin Third Central Hospital, Tianjin Medical University, Tianjin, China.
11
Department of Hepatology, Xinjiang Uygur Autonomous Region Traditional Chinese Medicine Hospital, Urumqi, Xinjiang, China.
12
Department of Gastroenterology, Tianjin Xiqing Hospital, Tianjin, China.
13
Department of Infectious Diseases, Affiliated Hospital of Yanbian University, Yanji, China.
PMID: 33277803 DOI: 10.1111/liv.14752
Abstract
Background & aims: Non-invasive assessment criteria to rule out high-risk varices (HRV) in compensated hepatitis B virus (HBV) cirrhosis on antiviral therapy remains unclear.
Methods: HBV-related compensated cirrhotic patients underwent screening endoscopy during antiviral therapy were enrolled and randomly divided into the derivation and validation sets. HRV were defined as medium to large varices or small varices with red signs. Univariate and multivariate logistic analysis were used to determine the parameters associated with HRV.
Results: A total of 436 HBV-related compensated cirrhotic patients screened for varices were enrolled, the median duration of antiviral therapy was 4 years (IQR: 2.5-5.5 years). In the derivation set (N = 290, 17.2% with HRV), only platelet (PLT) count (OR = 0.972, 95% CI 0.961-0.984, P <0.05) was independently associated with HRV, whereas liver stiffness measurement was not associated with the presence of HRV. With a PLT count cut-off value of 105 x109 /L, unnecessary endoscopies could be spared in 56.9% patients, with a 3.6%. risk of missing HRV. In the validation cohort (N = 146, 16.4% with HRV), the proportion of patients that could safely spare endoscopies (61.0%) identified by this PLT count cut-off value was higher than that obtained by using Baveno VI criteria (34.9%), with an acceptable risk of missing HRV (3.4%).
Conclusion: Compared with the "Baveno VI criteria or beyond" criteria, PLT count higher than 105 x109 /L could safely spare more screening endoscopies without increasing the risk of missing HRV in patients with HBV-related compensated cirrhosis on antiviral therapy.