Multicenter Retrospective Risk Assessment of Esophageal Variceal Bleeding in Patients with Cirrhosis: An Acoustic Radiation Force Impulse Elastography-Based Prediction Model
- Author:
Ja Yoon HEO
1
;
Beom Kyung KIM
;
Jun Yong PARK
;
Do Young KIM
;
Sang Hoon AHN
;
Won Young TAK
;
Young Oh KWEON
;
Kwang Hyub HAN
;
Soo Young PARK
;
Seung Up KIM
Author Information
- Publication Type:Multicenter Study
- Keywords: Acoustic radiation force impulse; Esophageal varix; Liver cirrhosis
- MeSH: Acoustics; Elasticity Imaging Techniques; Esophageal and Gastric Varices; Fibrosis; Follow-Up Studies; Hemorrhage; Humans; Incidence; Liver Cirrhosis; Male; Platelet Count; Retrospective Studies; Risk Assessment; ROC Curve; Sensitivity and Specificity; Spleen; Viperidae
- From:Gut and Liver 2019;13(2):206-214
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND/AIMS: Acoustic radiation force impulse (ARFI) elastography predicts the presence of esophageal varices (EVs). We investigated whether an ARFI-based prediction model can assess EV bleeding (EVB) risk in patients with cirrhosis. METHODS: The records of 262 patients with cirrhosis who underwent ARFI elastography and endoscopic surveillance at two institutions in 2008 to 2013 were retrospectively reviewed, and ARFI spleen diameter-to-platelet ratio scores (ASPS) were calculated. RESULTS: The median patient age (165 men, 97 women) was 56 years. The median ARFI velocity, spleen diameter, platelet count, and ASPS were 1.7 m/sec, 10.1 cm, 145×10⁹/L, and 1.16, respectively. During the median 38-month follow-up, 61 patients experienced EVB. Among all patients (179 without EVs and 83 with EVs), the cutoff value that maximized the sum of the sensitivity (73.1%) and specificity (78.4%) (area under receiver operating characteristic curve [AUROC], 0.824) for predicting EVB was 2.60. The cumulative EVB incidence was significantly higher in patients with ASPS ≥2.60 than in those with ASPS <2.60 (p<0.001). Among patients with EVs (n=83), 49 had high-risk EVs (HEVs), and 22 had EVB. The cumulative EVB incidence was significantly higher in HEV patients than in low-risk EV patients (p=0.037). At an ASPS of 4.50 (sensitivity, 66.7%; specificity, 70.6%; AUROC, 0.691), the cumulative EVB incidence was significantly higher in patients with a high ASPS than in those with a low ASPS (p=0.045). A higher ASPS independently predicted EVB (hazard ratio, 4.072; p=0.047). CONCLUSIONS: ASPS can assess EVB risk in patients with cirrhosis. Prophylactic management should be considered for patients with HEVs and ASPS ≥4.50.
