Published in:
Open Access 01-12-2021 | Esophageal Varices | Original Article
Development and Validation of an Easy-to-Use Risk Scoring System for Screening High-Risk Varices in Patients with HBV-Related Compensated Advanced Chronic Liver Disease
Published in: Digestive Diseases and Sciences | Issue 12/2021
Login to get accessAbstract
Background
A large portion of patients with compensated advanced chronic liver disease (cACLD) do not have varices or only have low risk varices.
Aims
To create and validate an easy-to-use risk scoring system to identify high-risk varices (HRV) and spare esophagogastroduodenoscopy (EGD) in patients with hepatitis B virus (HBV)-related cACLD.
Methods
In total, 334 patients with HBV-related cACLD who had undergone routine laboratory tests and ultrasound examination were enrolled. Multivariate logistic regression analysis was used to determine which variables were the independent risk factors for the presence of HRV, so as to establish the scoring system for screening HRV. The criteria were tested in a training cohort with 221 patients and validated in a validation cohort with 113 patients.
Results
In the training cohort, the prevalence of HRV was 29.5%. Albumin (ALB) [OR 0.83; 95% confidence index (CI) 0.77–0.90; P < 0.0001], platelet count (PLT) (OR 0.96, 95% CI 0.96–0.99; P < 0.0001) and portal vein diameter (OR 1.40; 95% CI 1.15–1.71; P = 0.001) were independent risk factors for the presence of HRV. The negative predictive value was > 95%, when albumin-platelet-portal vein diameter varices scores (APP score) were < 0.24. One hundred twenty-five of 221 (56.6%) patients met an APP score < 0.24 with a 4.8% HRV miss rate. In the validation cohort, 59 of 113 (51.3%) patients met the APP score < 0.24 with a 1.7% HRV miss rate.
Conclusions
APP score is a potential model for safely screening HRV and sparing EGDs in patients with HBV-related cACLD.