Validation of noninvasive methods to predict the presence of gastroesophageal varices in a cohort of patients with compensated advanced chronic liver disease
Validation of noninvasive methods to predict the presence of gastroesophageal varices in a cohort of patients with compensated advanced chronic liver disease
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DOI：
10.1111/jgh.13781
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发表时间：
2017-11-01
影响因子：
4.1
通讯作者：
Luis Calleja, Jose
中科院分区：
文献类型：
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作者：
Llop, Elba;Lopez, Marta;Luis Calleja, Jose
背景和目的：目的是验证非侵入性的方法来预测存在胃食管静脉曲张（GEV）的患者疑似代偿性晚期慢性liver diseases.Methods：我们回顾性分析了前瞻性收集的临床和放射学数据2013年9月至2015年9月。我们回顾了442例疑似代偿性晚期慢性肝病患者，通过瞬态弹性成像（TE）和胃镜检查进行测量。我们评估了血小板、脾脏直径、TE、肝脏硬度x脾脏大小/血小板（LSPS）、静脉曲张风险指数（VRI）、Baveno VI策略和Augustin算法。结果：442名患者中有161名被纳入。将GEV患者与无GEV患者进行比较，结果显示血小板计数（117 SD 51 vs 149 SD 62; P = 0.02）、脾直径（13.0 SD 1.9 vs 11.5 SD 2; P = 0.003）和TE（28 SD 15 vs 19 SD 10; P = 0.001）存在统计学显著差异。单一方法（血小板计数和TE）诊断正确率分别为51%和71.4%。联合方法（LSPS、VRI、Baveno VI和Augustin算法）诊断正确率分别为78%、83.6%、45.3%和57.1%。GEV误诊患者：血小板5/161（3.1%）、TE 6/161（3.7%）、LSPS 16/159（10%）、VRI 18/159（11.3%）、Baveno VI 3/161（1.8%）和Augustin算法6/161（3.7%）。不必要胃镜检查率：结论：TE、LSPS、VRI对肺癌的诊断准确率较高，但LSPS、VRI的误诊率较高。TE是最好的无创单一方法，Baveno VI策略是最好的组合方法。
Background and Aim: The aim was to validate noninvasive methods to predict the presence of gastroesophageal varices (GEV) in patients with suspected compensated advanced chronic liver disease.Methods: We retrospectively reviewed clinical and radiological data collected prospectively between September 2013 and September 2015. We reviewed 442 consecutive patients with suspected compensated advanced chronic liver disease measured by transient elastography (TE) and a gastroscopy. We evaluated platelets, spleen diameter, TE, liver stiffness x spleen size/platelets (LSPS), variceal risk index (VRI), Baveno VI strategy, and Augustin algorithm.Results: One hundred sixty-one out of 442 patients were included. Patients with GEV were compared with patients without GEV and showed statistically significant differences in platelet count (117 SD 51 vs 149 SD 62; P = 0.02), spleen diameter (13.0 SD 1.9 vs 11.5 SD 2; P = 0.003), and TE (28 SD 15 vs 19 SD 10; P = 0.001). Single methods (platelet count and TE) diagnosed correctly 51% and 71.4% of patients. Combined methods (LSPS, VRI, Baveno VI, and Augustin algorithm) diagnosed correctly 78%, 83.6%, 45.3%, and 57.1% of patients. Patients with GEV misdiagnosed: platelets 5/161 (3.1%), TE 6/161 (3.7%), LSPS 16/159 (10%), VRI 18/159 (11.3%), Baveno VI 3/161 (1.8%), and Augustin algorithm 6/161 (3.7%). Rate of unnecessary gastroscopies: platelets 46%, TE 25%, LSPS 13%, VRI 6%, Baveno VI 53%, and Augustin algorithm 39.1%.Conclusions: A significant number of patients were classified correctly using TE, LSPS, and VRI; however, LSPS and VRI had unacceptable rates of misdiagnoses. TE is the best noninvasive single method and the Baveno VI strategy the best combined method.