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Ultrasonic spleen thickness-based indexes surpass Baveno VI criteria in high-risk gastroesophageal varices detection

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Abstract

Aims

To evaluate the efficiency of ultrasonic spleen thickness (UST), routine variables and (expanded) Baveno VI criteria for high-risk gastroesophageal varices (HRGOV) detection in cirrhotic patients.

Methods

In total, 305 cirrhotic patients were retrospectively enrolled in the deriving cohort and 328 cirrhotic patients with hepatitis B sustained viral response were prospectively enrolled in the validation cohort. HRGOV was defined as medium and severe gastroesophageal varices (GOV), mild GOV with red signs or Child–Pugh C. The cut-offs for HRGOV were determined by likelihood ratio indicating strong evidences. Algorithms of Spleen thickness-Age-Liver stiffness measurement (LSM, by Fibroscan®)-Albumin (SALA) and Spleen thickness-Platelet-Albumin (SPA) were derived by multivariate analyses.

Results

The area under receiver operating characteristics curve of SALA, SPA, UST, platelet, and LSM were 0.849, 0.835, 0.808, 0.746, and 0.655 in the deriving cohort, and improved to 0.901, 0.904, 0.858, 0.876, and 0.811 in the validation cohort, respectively. While SALA, SPA, UST, platelet, Baveno VI criteria (BVI), and expanded BVI spared 46.6%, 38.0%, 29.2%, 21.0%, 12.1%, and 23.6% esophagogastroduodenoscopy in the deriving cohort, these numbers were improved to 68.1%, 66.8%, 27.1%, 37.8%, 36.0%, and 61.0% in the validating cohort, respectively; however, the negative likelihood ratio of expanded BVI was up to 0.16. SPA spared less esophagogastroduodenoscopy than SALA, which can be supplemented by stepwise applying UST and SPA. Sequentially combining UST and SALA, BVI and SALA exempted additional 10–5% endoscopies.

Conclusions

SPA, without LSM, improves HRGOV detection comparing with BVI. UST based algorithms combination can achieve the best efficiency especially in sustained virus response hepatitis B.

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Availability of data and materials

Data and material of the study are available to all authors.

Code availability

Not applicable.

Abbreviations

GOV:

Gastroesophageal varices

NSBB:

Non-selective beta blockers

EGD:

Esophagogastroduodenoscopy

LSM:

Liver stiffness measurement

TE:

Transient elastography

HRGOV:

High-risk gastroesophageal varices

UST:

Ultrasonic spleen thickness

HBSVR:

Hepatitis B sustained viral response

LSPS:

LSM-spleen diameter to platelet ratio score

PSR:

Platelet count to spleen diameter ratio

AUROC:

Area under receiver operating characteristics curve

CI:

Confidence internal

PLR:

Positive likelihood ratio

NLR:

Negative likelihood ratio

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Funding

This study was supported by National Science and Technology Major Project of China (2017ZX10203202-003-004 and 2018ZX10302204-001-002), National Natural Science Foundation of China (81802011), and Sanming Project of Medicine in Shenzhen (SZSM201911001).

Author information

Author notes

  1. Xie-Er Liang, Xiao-Min Hu and Hai-Yu Wang have contributed to this work equally.

Authors and Affiliations

  1. Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou North Avenue, Guangzhou, 510515, Guangdong, China

    Xie-Er Liang, Hai-Yu Wang, Lin Dai, Xiao-Yu Lin, Jin-Jun Chen, Yong-Peng Chen, Biao Wen & Rong-Long Jiang

  2. Hepatology Unit, Shenzhen Hospital, Southern Medical University, No. 1333 Xinhu Road, Shenzhen, 518110, Guangdong, China

    Xiao-Min Hu, Yong-Peng Chen & Rong-Long Jiang

  3. Department of Gastroenterology, The First Affiliated Hospital of Chengdu Medical College, No. 278 Baoguang Road, Chengdu, 610000, Sichuan, China

    Biao Wen

Authors
  1. Xie-Er Liang
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Contributions

The study conception and design were contributed by X-EL, X-MH, H-YW, Y-PC, BW, and R-LJ. Material preparation, data collection and analysis were performed by all authors. The first draft of the manuscript was written by X-EL, X-MH, and H-YW, and reedited by Y-PC, BW, and R-LJ. All authors commented on previous versions of the manuscript and approved the final manuscript.

Corresponding authors

Correspondence to Yong-Peng Chen, Biao Wen or Rong-Long Jiang.

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Conflict of interest

Xie-Er Liang, Xiao-Min Hu, Hai-Yu Wang, Lin Dai, Xiao-Yu Lin, Jin-Jun Chen, Yong-Peng Chen, Biao Wen and Rong-Long Jiang declare that they have no conflict of interest.

Ethics approval

The study protocol was consistent with the ethical guidelines of the Declaration of Helsinki (1975), as revised in 2008 (5), and was approved by the Institutional Review Boards of Nanfang Hospital (NFEC-201901-K14). (Clinical-Trials.gov: NCT04123509).

Consent to participate

Informed consent was obtained from all patients for being included in the study.

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All authors commented on previous versions of the manuscript and approved for publication of the final manuscript.

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Liang, XE., Hu, XM., Wang, HY. et al. Ultrasonic spleen thickness-based indexes surpass Baveno VI criteria in high-risk gastroesophageal varices detection. Hepatol Int 16, 649–657 (2022). https://doi.org/10.1007/s12072-022-10327-6

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  • DOI: https://doi.org/10.1007/s12072-022-10327-6

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