Prediction of High-Risk Varices in Patients with Compensated Advanced Chronic Liver Disease in Saudi Arabia

Abstract

Purpose

Liver stiffness and low platelet count can predict portal hypertension and high-risk varices (HRVs) in patients with cirrhosis. Thus, screening endoscopy may not be required for all patients with compensated advanced chronic liver disease (cACLD). However, data from Saudi Arabia are limited. This study aimed to validate the Baveno VI and expanded Baveno VI criteria for screening endoscopy and identify the risk factors associated with HRVs in patients with cACLD in Saudi Arabia.

Patients and Methods

We analyzed data from 215 patients with cACLD diagnosed on transient elastography (LSM > 10 kPa) and had paired platelet count and screening upper endoscopy performed within one year of diagnosis. HRVs or varices needing treatment (VNTs) were defined as medium-to-large esophageal varices (EVs), small EVs with red flags, or gastric varices. Sensitivity, specificity, and area under the receiver operating characteristic curve were calculated. Univariate and multivariate logistic regression analyses identified HRV risk factors.

Results

The Baveno VI criteria spared 50.7% of endoscopies, missing 3.7% of VNTs, while the expanded Baveno VI criteria spared 63.7% of endoscopies, missing 5.1% VNTs. An LSM <20 kPa and platelet count > 150,000/µL were associated with HRV in 8.1% and 8.3%, respectively. While an LSM <25 kPa and platelet count > 110,000/µL were associated with HRV in 9.7% and 9%, respectively. The Baveno VI criteria had sensitivity and specificity of 76% and 55%, while the expanded criteria had 67% and 69%, respectively. Baveno VI criteria performed better in hepatitis C virus patients than nonalcoholic fatty liver disease patients. Multivariate logistic regression analysis revealed platelet count and LSM as predictors of HRV.

Conclusion

The Baveno VI criteria effectively identified HRVs in cACLD patients from Saudi Arabia, reducing unnecessary endoscopies. Although the expanded criteria avoided more endoscopies, it led to a higher rate of missed HRVs.

Keywords:

• esophageal varices
• elastography
• spared endoscopies
• cirrhosis
• Saudi Arabia

Acknowledgments

The author thanks Dr. Aiman El-Saed (at Infection Prevention and Control Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia) for his help with statistical analysis.

Disclosure

The author reports no conflicts of interest in relation to this work.