Liver stiffness plus platelet count can be used to exclude high-risk oesophageal varices

摘要

Background/Aims: Endoscopic screening for high-risk gastro-oesophageal varices (GOV) is recommended for compensated cirrhotic patients with transient elastography identifying increasing numbers of patients with cirrhosis without portal hypertension. Using liver stiffness measurement (LSM) +/- platelet count, the aim was to develop a simple clinical rule to exclude the presence of high-risk GOV in patients with Child-Pugh A cirrhosis. Methods: A retrospective analysis of 71 patients with Child-Pugh A cirrhosis diagnosed by transient elastography (LSM > 13.6 kPa) who underwent screening gastroscopy was conducted. A predictive model using LSM +/- platelet count was assessed to exclude the presence of high-risk GOV (diameter >5 mm and/or the presence of high-risk stigmata) and validated using a second cohort of 200 patients from two independent centres. Results: High-risk GOV were present in 10 (15%) and 16 (8%) of the training and validation cohorts, respectively, which was associated with LSM and Pl count (P < 0.05). A combined model based on LSM and Pl count was more accurate for excluding the presence of high-risk GOV than either alone (training cohort AUROC: 0.87 [0.77-0.96] vs. 0.78 [0.65-0.92] for LSM and 0.71 [0.52-0.90] for platelets) with the combination of LSM <= 25 kPa and Pl >= 100 having a NPV of 100% in both the training and validation cohorts. A total of 107 (39%) patients meet this criterion. Conclusion: The combination of LSM <= 25 kPa and Pl >= 100 can be used in clinical practice to exclude the presence of high-riskGOV in patients with Child-Pugh A cirrhosis.