Non-invasive tools and risk of clinically significant portal hypertension and varices in compensated cirrhosis: The “Anticipate” study.Abraldes JG, Bureau C, Stefanescu H, Augustin S, Ney M, Blasco H, Procopet B, Bosch J, Genesca J, Berzigotti A; Anticipate Investigators. Hepatology. 2016 Sep 17. [Epub ahead of print]
In patients with compensated advanced chronic liver disease (cACLD) the presence of clinically significant portal hypertension (CSPH) and varices needing treatment (VNT) bears prognostic and therapeutic implications. Our aim was to develop non-invasive tests based risk prediction models to provide a point-of-care risk assessment of cACLD patients.
We analyzed 518 patients with cACLD from 5 centers in Europe/Canada with paired non-invasive tests (liver stiffness by transient elastography(LSM), platelet count and spleen diameter with calculation of LSPS score and platelet-spleen ratio (PSR)) and endoscopy/HVPG measurement. Risk of CSPH, varices and VNT was modeled with logistic regression. All non-invasive tests reliably identified patients with high-risk of CSPH, and LSPS had the highest discrimination. LSPS values above 2.65 were associated with risks of CSPH above 80%. None of the tests identified patients with very low risk of all-size varices, but both LSPS and a model combining TE and platelet count identified patients with very low risk (<5%) risk of VNT, suggesting that they could be used to triage patients requiring screening endoscopy. LSPS values of <1.33 were associated with a <5% risk of VNT, and 26% of patients had values below this threshold. LSM combined with Platelet count predicted a risk <5% of VNT in 30% of the patients. Nomograms were developed to facilitate point-of-care risk assessment. In conclusion, a significant proportion of patients with a very high risk of CSPH and a population with a very low risk of VNT can be identified with simple non-invasive tests suggesting that these can be used to individualize medical care.