Journal Information
Journal ID (publisher-id): BM
Journal ID (nlm-ta): Biochem Med (Zagreb)
Title: Biochemia Medica
Abbreviated Title: Biochem. Med. (Zagreb)
ISSN (print): 1330-0962
ISSN (electronic): 1846-7482
Publisher: Croatian Society of Medical Biochemistry and Laboratory Medicine
Article Information
Copyright statement: ©Croatian Society of Medical Biochemistry and Laboratory Medicine.
Copyright: 2022, Croatian Society of Medical Biochemistry
License (open-access):
This is an Open Access article distributed under the terms of the Creative Commons Attribution (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Date received: 07 November 2021
Date accepted: 10 April 2022
Publication date (print and electronic): 15 June 2022
Volume: 32
Issue: 2
Electronic Location Identifier: 020712
Publisher ID: bm-32-2-020712
DOI: 10.11613/BM.2022.020712
Use of biochemical parameters for non-invasive screening of oesophageal varices in comparison to elastography-based approach in patients with compensated advanced chronic liver disease
Frane Pastrovic[1]
Anita Madir[2]
Kristian Podrug[3]
Marko Zelenika[1]
Sanda Mustapic[1]
Adriana Unic[6]
Lovorka Derek[7]
[1] Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, Zagreb, Croatia
[2] University of Zagreb School of Medicine, Zagreb, Croatia
[3] Department of Gastroenterology and Hepatology, University Hospital Split, Split, Croatia
[4] Department of Hematology, University Hospital Dubrava, Zagreb, Croatia
[5] University of Zagreb Faculty of Pharmacy and Biochemistry, Zagreb, Croatia
[6] Department of Clinical Chemistry, University Hospital Centre Sestre Milosrdnice, Zagreb, Croatia
[7] Clinical Department for Laboratory Diagnostics, University Hospital Dubrava, Zagreb, Croatia
Author notes:
[*] Corresponding author: ivica.grgurevic@zg.htnet.hr
Introduction
Oesophageal varices are routinely diagnosed by esophagogastroduodenoscopy (EGD), and their bleeding has high mortality. We aimed to evaluate diagnostic performance of biochemical tests in comparison to elastography-based approaches, as non-invasive alternatives to EGD, for ruling-out high risk oesophageal varices (HRV).
Material and methods
Retrospective analysis of patients (N = 861) who underwent liver stiffness measurement (LSM) by transient elastography (TE) in a single centre over 5-year period, with available results of EGD (within 3 months from LSM). Only patients with suspicion of compensated advanced chronic liver disease (cACLD) defined by LSM ≥ 10 kPa were included comprising the final cohort of 73 subjects. Original and expanded Baveno VI criteria (B6C), controlled attenuation parameter (CAP), platelet count (PLT), aspartate aminotransferase to PLT ratio index (APRI), Fibrosis-4 index (FIB4), model for end stage liver disease (MELD) score were evaluated against the results of EGD that served as the reference method.
Results
Analysed patients had median age 62 years, 59/73 (0.81) were males, 54/73 (0.74) had alcoholic/non-alcoholic fatty liver disease, and 21/73 (0.29) had HRV. In multivariate logistic regression analysis only LSM and PLT were independently associated with HRV. The best performing tests for ruling-out HRV (% of spared EGD; % of missed HRV) were respectively: LSM < 20 kPa (53.4%; 0%), B6C (38%; 0%), Expanded B6C (47.9%; 4.8%); PLT > 214x109/L (21.9%; 0%); FIB4 ≤ 1.8 (21.4%; 0%), APRI ≤ 0.34 (12.3%; 0%). CAP, MELD = 6 alone or combined with PLT > 150(x109/L) did not show acceptable performance.
Keywords: portal hypertension; cirrhosis; platelet count; esophageal varices; non-invasive tests
