Abstract
Aims
To prospectively evaluate the performance of spleen stiffness measurement (SSM) and
liver stiffness measurement (LSM) via acoustic radiation force impulse (ARFI) imaging
combined with platelet counts (PLT) in ruling out HRV in HBV-related cirrhotic patients
with viral suppression.
Methods
Patients with cirrhosis enrolled between June 2020-March 2022 were divided into a
derivation cohort and validation cohort. LSM and SSM ARFI-based, and esophagogastroduodenoscopy
(EGD) were performed at enrollment.
Results
In the derivation cohort, overall, 236 HBV-related cirrhotic patients with maintained
viral suppression were enrolled, and the prevalence of HRV was 19.5% (46/236). With
the aim of identifying HRV, the most accurate LSM and SSM cut-offs were chosen of
1.46 m/s and 2.28 m/s, respectively. The combined model (LSM<1.46 m/s and PLT>150 × 109/L strategy combined with SSM ≤ 2.28 m/s) can spare 38.6% of EGDs and 4.3% of HRV
cases were misclassified. In the validation cohort, we analysed 323 HBV-related cirrhotic
patients with maintained viral suppression and validated the combined model can spare
33.4% (108/323) of EGD, and the HRV missed rate was 3.4%.
Conclusions
A non-invasive prediction model combining LSM<1.46 m/s and PLT>150 × 109/L strategy with SSM ≤ 2.28 m/s exhibited excellent performance in ruling out HRV
and avoided a significantly large number (38.6% vs 33.4%) of unnecessary EGDs in HBV-related
cirrhotic patients with viral suppression.
Keywords
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References
- Expanding consensus in portal hypertension: report of the Baveno VI consensus workshop: stratifying risk and individualizing care for portal hypertension.J Hepatol. 2015; 63: 743-752
- Baveno VI criteria and spleen stiffness measurement rule out high-risk varices in virally suppressed HBV-related cirrhosis.J Hepatol. 2021; 74: 584-592
- Baveno VII - renewing consensus in portal hypertension.J Hepatol. 2022; 76: 959-974
- Liver cirrhosis.Lancet. 2014; 383: 1749-1761
- Comparison of the reliability of acoustic radiation force impulse imaging and supersonic shear imaging in measurement of liver stiffness.Radiology. 2015; 277: 881-886
- EFSUMB guidelines and recommendations on the clinical use of liver ultrasound elastography, update 2017 (long version).Ultraschall Med. 2017; 38: e16-e47
- Update on hepatitis B virus infection.World J Gastroenterol. 2014; 20: 13293-13305
- Validation of Baveno VI criteria for screening and surveillance of esophageal varices in patients with compensated cirrhosis and a sustained response to antiviral therapy.Gastroenterology. 2019; 156: 997-1009
- A combined model based on spleen stiffness measurement and Baveno VI criteria to rule out high-risk varices in advanced chronic liver disease.J Hepatol. 2018; 69: 308-317
- Eradication of hepatitis C virus infection in patients with cirrhosis reduces risk of liver and non-liver complications.Gastroenterology. 2017; 152: 142-156
- Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance.Hepatology. 2018; 67: 1560-1599
- Application of supersonic shear imaging to the Baveno VI criteria and a combination model with spleen stiffness measurement to rule out high-risk varices in compensated advanced chronic liver disease.Ultraschall Med. 2020;
- On-treatment changes of liver stiffness at week 26 could predict 2-year clinical outcomes in HBV-related compensated cirrhosis.Liver Int. 2018; 38: 1045-1054
- Clinical outcome and hemodynamic changes following HCV eradication with oral antiviral therapy in patients with clinically significant portal hypertension.J Hepatol. 2020; 73: 1415-1424
- Measurement of spleen stiffness by acoustic radiation force impulse imaging identifies cirrhotic patients with esophageal varices.Gastroenterology. 2013; 144: 92-101
- Portal hypertension in patients with liver cirrhosis: diagnostic accuracy of spleen stiffness.Radiology. 2016; 279: 609-619
- Non-invasive response prediction in prophylactic carvedilol therapy for cirrhotic patients with esophageal varices.J Hepatol. 2019; 70: 412-422
- A strategy for varices screening based on acoustic radiation force impulse combined with platelet (CHESS2001): an alternative of Baveno VI criteria.Hepatol Commun. 2022; 6: 3154-3162
- EASL clinical practice Guidelines for the management of patients with decompensated cirrhosis.J Hepatol. 2018; 69: 406-460
- Non-invasive evaluation of portal hypertension using ultrasound elastography.J Hepatol. 2017; 67: 399-411
Article info
Publication history
Published online: March 01, 2023
Accepted:
February 14,
2023
Received:
November 17,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
