Non-invasive prediction of esophageal varices by stiffness and platelet in non-alcoholic fatty liver disease cirrhosis

Salvatore Petta, Giada Sebastiani, Elisabetta Bugianesi, Mauro Viganò, Vincent Wai Sun Wong, Annalisa Berzigotti, Anna Ludovica Fracanzani, Quentin M. Anstee, Fabio Marra, Marco Barbara, Vincenza Calvaruso, Calogero Cammà, Vito Di Marco, Antonio Craxì, Victor de Ledinghen

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background & Aims: Baveno VI and expanded Baveno VI criteria can avoid the need for esophagogastroduodenoscopy (EGD) to screen for varices needing treatment (VNT) in a substantial proportion of compensated patients with viral and/or alcoholic cirrhosis. This multicenter, cross-sectional study aims to validate these criteria in patients with compensated cirrhosis due to non-alcoholic fatty liver disease (NAFLD), accounting for possible differences in liver stiffness measurement (LSM) values between M and XL probes. Methods: We assessed 790 patients with NAFLD-related compensated cirrhosis who had EGD within six months of a reliable LSM, measured by FibroScan® using M and/or XL probe. Baveno VI and expanded Baveno VI criteria were tested. The main variable used to optimize criteria was the percentage of endoscopies spared, keeping the risk of missing large VNT below a 5% threshold. Results: LSM was measured by both M and XL probes (training set) in 314 patients, while only M or XL probe (validation sets) were used to measure LSM in 338 and 138 patients, respectively. In the training set, use of Baveno VI and expanded Baveno VI criteria reduced the number of EGD by 33.3% and by 58%, with 0.9% and 3.8% of large esophageal varices missed, respectively. The best thresholds to rule-out VNT were identified as platelet count >110,000/mm3 and LSM <30 kPa for M probe, and platelet count >110,000/mm3 and LSM <25 kPa for XL probe (NAFLD cirrhosis criteria). Thus, usage of NAFLD cirrhosis criteria would have led to an absolute reduction in the number of EGD screened patients of 34.7% and 10.5% with respect to Baveno VI and expanded Baveno VI criteria, respectively. Conclusion: The new NAFLD cirrhosis criteria, established for the FibroScan probe, can reduce the use of EGD for screening of VNT in NAFLD cirrhosis by more than half, with a chance of missing VNT below 5%. Lay summary: In non-alcoholic fatty liver disease-related compensated cirrhosis, the expanded Baveno VI criteria work better than the Baveno VI criteria for ruling out the presence of varices needing treatment, sparing unnecessary and invasive screening procedures. New diagnostic criteria for this patient group, based on liver stiffness measurement and platelet count, and optimized for the specific FibroScan® probe used, work better than both Baveno VI and expanded Baveno VI criteria. The accuracy of all non-invasive scoring criteria was lower in non-obese patients.

Original languageEnglish
Pages (from-to)878-885
Number of pages8
JournalJournal of Hepatology
Volume69
Issue number4
DOIs
Publication statusPublished - Oct 1 2018

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Esophageal and Gastric Varices
Liver Cirrhosis
Digestive System Endoscopy
Varicose Veins
Blood Platelets
Liver
Fibrosis
Platelet Count
Therapeutics
Alcoholic Liver Cirrhosis
Non-alcoholic Fatty Liver Disease
Endoscopy
Cross-Sectional Studies

Keywords

  • Baveno
  • Cirrhosis
  • NAFLD
  • Stiffness
  • Varices

ASJC Scopus subject areas

  • Hepatology

Cite this

Petta, S., Sebastiani, G., Bugianesi, E., Viganò, M., Wong, V. W. S., Berzigotti, A., ... de Ledinghen, V. (2018). Non-invasive prediction of esophageal varices by stiffness and platelet in non-alcoholic fatty liver disease cirrhosis. Journal of Hepatology, 69(4), 878-885. https://doi.org/10.1016/j.jhep.2018.05.019

Non-invasive prediction of esophageal varices by stiffness and platelet in non-alcoholic fatty liver disease cirrhosis. / Petta, Salvatore; Sebastiani, Giada; Bugianesi, Elisabetta; Viganò, Mauro; Wong, Vincent Wai Sun; Berzigotti, Annalisa; Fracanzani, Anna Ludovica; Anstee, Quentin M.; Marra, Fabio; Barbara, Marco; Calvaruso, Vincenza; Cammà, Calogero; Di Marco, Vito; Craxì, Antonio; de Ledinghen, Victor.

In: Journal of Hepatology, Vol. 69, No. 4, 01.10.2018, p. 878-885.

Research output: Contribution to journalArticle

Petta, S, Sebastiani, G, Bugianesi, E, Viganò, M, Wong, VWS, Berzigotti, A, Fracanzani, AL, Anstee, QM, Marra, F, Barbara, M, Calvaruso, V, Cammà, C, Di Marco, V, Craxì, A & de Ledinghen, V 2018, 'Non-invasive prediction of esophageal varices by stiffness and platelet in non-alcoholic fatty liver disease cirrhosis', Journal of Hepatology, vol. 69, no. 4, pp. 878-885. https://doi.org/10.1016/j.jhep.2018.05.019
Petta, Salvatore ; Sebastiani, Giada ; Bugianesi, Elisabetta ; Viganò, Mauro ; Wong, Vincent Wai Sun ; Berzigotti, Annalisa ; Fracanzani, Anna Ludovica ; Anstee, Quentin M. ; Marra, Fabio ; Barbara, Marco ; Calvaruso, Vincenza ; Cammà, Calogero ; Di Marco, Vito ; Craxì, Antonio ; de Ledinghen, Victor. / Non-invasive prediction of esophageal varices by stiffness and platelet in non-alcoholic fatty liver disease cirrhosis. In: Journal of Hepatology. 2018 ; Vol. 69, No. 4. pp. 878-885.
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abstract = "Background & Aims: Baveno VI and expanded Baveno VI criteria can avoid the need for esophagogastroduodenoscopy (EGD) to screen for varices needing treatment (VNT) in a substantial proportion of compensated patients with viral and/or alcoholic cirrhosis. This multicenter, cross-sectional study aims to validate these criteria in patients with compensated cirrhosis due to non-alcoholic fatty liver disease (NAFLD), accounting for possible differences in liver stiffness measurement (LSM) values between M and XL probes. Methods: We assessed 790 patients with NAFLD-related compensated cirrhosis who had EGD within six months of a reliable LSM, measured by FibroScan{\circledR} using M and/or XL probe. Baveno VI and expanded Baveno VI criteria were tested. The main variable used to optimize criteria was the percentage of endoscopies spared, keeping the risk of missing large VNT below a 5{\%} threshold. Results: LSM was measured by both M and XL probes (training set) in 314 patients, while only M or XL probe (validation sets) were used to measure LSM in 338 and 138 patients, respectively. In the training set, use of Baveno VI and expanded Baveno VI criteria reduced the number of EGD by 33.3{\%} and by 58{\%}, with 0.9{\%} and 3.8{\%} of large esophageal varices missed, respectively. The best thresholds to rule-out VNT were identified as platelet count >110,000/mm3 and LSM <30 kPa for M probe, and platelet count >110,000/mm3 and LSM <25 kPa for XL probe (NAFLD cirrhosis criteria). Thus, usage of NAFLD cirrhosis criteria would have led to an absolute reduction in the number of EGD screened patients of 34.7{\%} and 10.5{\%} with respect to Baveno VI and expanded Baveno VI criteria, respectively. Conclusion: The new NAFLD cirrhosis criteria, established for the FibroScan probe, can reduce the use of EGD for screening of VNT in NAFLD cirrhosis by more than half, with a chance of missing VNT below 5{\%}. Lay summary: In non-alcoholic fatty liver disease-related compensated cirrhosis, the expanded Baveno VI criteria work better than the Baveno VI criteria for ruling out the presence of varices needing treatment, sparing unnecessary and invasive screening procedures. New diagnostic criteria for this patient group, based on liver stiffness measurement and platelet count, and optimized for the specific FibroScan{\circledR} probe used, work better than both Baveno VI and expanded Baveno VI criteria. The accuracy of all non-invasive scoring criteria was lower in non-obese patients.",
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author = "Salvatore Petta and Giada Sebastiani and Elisabetta Bugianesi and Mauro Vigan{\`o} and Wong, {Vincent Wai Sun} and Annalisa Berzigotti and Fracanzani, {Anna Ludovica} and Anstee, {Quentin M.} and Fabio Marra and Marco Barbara and Vincenza Calvaruso and Calogero Camm{\`a} and {Di Marco}, Vito and Antonio Crax{\`i} and {de Ledinghen}, Victor",
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T1 - Non-invasive prediction of esophageal varices by stiffness and platelet in non-alcoholic fatty liver disease cirrhosis

AU - Petta, Salvatore

AU - Sebastiani, Giada

AU - Bugianesi, Elisabetta

AU - Viganò, Mauro

AU - Wong, Vincent Wai Sun

AU - Berzigotti, Annalisa

AU - Fracanzani, Anna Ludovica

AU - Anstee, Quentin M.

AU - Marra, Fabio

AU - Barbara, Marco

AU - Calvaruso, Vincenza

AU - Cammà, Calogero

AU - Di Marco, Vito

AU - Craxì, Antonio

AU - de Ledinghen, Victor

PY - 2018/10/1

Y1 - 2018/10/1

N2 - Background & Aims: Baveno VI and expanded Baveno VI criteria can avoid the need for esophagogastroduodenoscopy (EGD) to screen for varices needing treatment (VNT) in a substantial proportion of compensated patients with viral and/or alcoholic cirrhosis. This multicenter, cross-sectional study aims to validate these criteria in patients with compensated cirrhosis due to non-alcoholic fatty liver disease (NAFLD), accounting for possible differences in liver stiffness measurement (LSM) values between M and XL probes. Methods: We assessed 790 patients with NAFLD-related compensated cirrhosis who had EGD within six months of a reliable LSM, measured by FibroScan® using M and/or XL probe. Baveno VI and expanded Baveno VI criteria were tested. The main variable used to optimize criteria was the percentage of endoscopies spared, keeping the risk of missing large VNT below a 5% threshold. Results: LSM was measured by both M and XL probes (training set) in 314 patients, while only M or XL probe (validation sets) were used to measure LSM in 338 and 138 patients, respectively. In the training set, use of Baveno VI and expanded Baveno VI criteria reduced the number of EGD by 33.3% and by 58%, with 0.9% and 3.8% of large esophageal varices missed, respectively. The best thresholds to rule-out VNT were identified as platelet count >110,000/mm3 and LSM <30 kPa for M probe, and platelet count >110,000/mm3 and LSM <25 kPa for XL probe (NAFLD cirrhosis criteria). Thus, usage of NAFLD cirrhosis criteria would have led to an absolute reduction in the number of EGD screened patients of 34.7% and 10.5% with respect to Baveno VI and expanded Baveno VI criteria, respectively. Conclusion: The new NAFLD cirrhosis criteria, established for the FibroScan probe, can reduce the use of EGD for screening of VNT in NAFLD cirrhosis by more than half, with a chance of missing VNT below 5%. Lay summary: In non-alcoholic fatty liver disease-related compensated cirrhosis, the expanded Baveno VI criteria work better than the Baveno VI criteria for ruling out the presence of varices needing treatment, sparing unnecessary and invasive screening procedures. New diagnostic criteria for this patient group, based on liver stiffness measurement and platelet count, and optimized for the specific FibroScan® probe used, work better than both Baveno VI and expanded Baveno VI criteria. The accuracy of all non-invasive scoring criteria was lower in non-obese patients.

AB - Background & Aims: Baveno VI and expanded Baveno VI criteria can avoid the need for esophagogastroduodenoscopy (EGD) to screen for varices needing treatment (VNT) in a substantial proportion of compensated patients with viral and/or alcoholic cirrhosis. This multicenter, cross-sectional study aims to validate these criteria in patients with compensated cirrhosis due to non-alcoholic fatty liver disease (NAFLD), accounting for possible differences in liver stiffness measurement (LSM) values between M and XL probes. Methods: We assessed 790 patients with NAFLD-related compensated cirrhosis who had EGD within six months of a reliable LSM, measured by FibroScan® using M and/or XL probe. Baveno VI and expanded Baveno VI criteria were tested. The main variable used to optimize criteria was the percentage of endoscopies spared, keeping the risk of missing large VNT below a 5% threshold. Results: LSM was measured by both M and XL probes (training set) in 314 patients, while only M or XL probe (validation sets) were used to measure LSM in 338 and 138 patients, respectively. In the training set, use of Baveno VI and expanded Baveno VI criteria reduced the number of EGD by 33.3% and by 58%, with 0.9% and 3.8% of large esophageal varices missed, respectively. The best thresholds to rule-out VNT were identified as platelet count >110,000/mm3 and LSM <30 kPa for M probe, and platelet count >110,000/mm3 and LSM <25 kPa for XL probe (NAFLD cirrhosis criteria). Thus, usage of NAFLD cirrhosis criteria would have led to an absolute reduction in the number of EGD screened patients of 34.7% and 10.5% with respect to Baveno VI and expanded Baveno VI criteria, respectively. Conclusion: The new NAFLD cirrhosis criteria, established for the FibroScan probe, can reduce the use of EGD for screening of VNT in NAFLD cirrhosis by more than half, with a chance of missing VNT below 5%. Lay summary: In non-alcoholic fatty liver disease-related compensated cirrhosis, the expanded Baveno VI criteria work better than the Baveno VI criteria for ruling out the presence of varices needing treatment, sparing unnecessary and invasive screening procedures. New diagnostic criteria for this patient group, based on liver stiffness measurement and platelet count, and optimized for the specific FibroScan® probe used, work better than both Baveno VI and expanded Baveno VI criteria. The accuracy of all non-invasive scoring criteria was lower in non-obese patients.

KW - Baveno

KW - Cirrhosis

KW - NAFLD

KW - Stiffness

KW - Varices

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