Prediction of Esophageal Varices by Liver Stiffness and Platelets in Persons With Human Immunodeficiency Virus Infection and Compensated Advanced Chronic Liver Disease
© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissionsoup.com..
BACKGROUND: People living with human immunodeficiency virus (PLWH) are at increased risk of cirrhosis and esophageal varices. Baveno VI criteria, based on liver stiffness measurement (LSM) and platelet count, have been proposed to avoid unnecessary esophagogastroduodenoscopy (EGD) screening for esophageal varices needing treatment (EVNT). This approach has not been validated in PLWH.
METHODS: PLWH from 8 prospective cohorts were included if they fulfilled the following criteria: (1) compensated advanced chronic liver disease (LSM >10 kPa); (2) availability of EGD within 6 months of reliable LSM. Baveno VI (LSM <20 kPa and platelets >150 000/μL), expanded Baveno VI (LSM <25 kPa and platelets >110 000/μL), and Estudio de las Hepatitis Víricas (HEPAVIR) criteria (LSM <21 kPa) were applied to identify patients not requiring EGD screening. Criteria optimization was based on the percentage of EGDs spared, while keeping the risk of missing EVNT <5%.
RESULTS: Five hundred seven PLWH were divided into a training (n = 318) and a validation set (n = 189). EVNT were found in 7.5%. In the training set, Baveno VI, expanded Baveno VI, and HEPAVIR criteria spared 10.1%, 25.5%, and 28% of EGDs, while missing 0%, 1.2%, and 2.2% of EVNT, respectively. The best thresholds to rule out EVNT were platelets >110 000/μL and LSM <30 kPa (HIV cirrhosis criteria), with 34.6% of EGDs spared and 0% EVNT missed. In the validation set, HEPAVIR and HIV cirrhosis criteria spared 54% and 48.7% of EGDs, while missing 4.9% and 2.2% EVNT, respectively.
CONCLUSIONS: Baveno VI criteria can be extended to HEPAVIR and HIV cirrhosis criteria while sparing a significant number of EGDs, thus improving resource utilization for PLWH with compensated advanced chronic liver disease.
| Errataetall: |
CommentIn: Clin Infect Dis. 2021 May 18;72(10):1862-1863. - PMID 32658255 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:71 |
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| Enthalten in: |
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America - 71(2020), 11 vom: 31. Dez., Seite 2810-2817 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Merchante, Nicolás [VerfasserIn] |
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| Links: |
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| Themen: |
Baveno VI criteria |
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| Anmerkungen: |
Date Completed 28.04.2021 Date Revised 30.06.2021 published: Print CommentIn: Clin Infect Dis. 2021 May 18;72(10):1862-1863. - PMID 32658255 Citation Status MEDLINE |
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| doi: |
10.1093/cid/ciz1181 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM304155144 |
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| 245 | 1 | 0 | |a Prediction of Esophageal Varices by Liver Stiffness and Platelets in Persons With Human Immunodeficiency Virus Infection and Compensated Advanced Chronic Liver Disease |
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| 500 | |a Date Revised 30.06.2021 | ||
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| 500 | |a CommentIn: Clin Infect Dis. 2021 May 18;72(10):1862-1863. - PMID 32658255 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissionsoup.com. | ||
| 520 | |a BACKGROUND: People living with human immunodeficiency virus (PLWH) are at increased risk of cirrhosis and esophageal varices. Baveno VI criteria, based on liver stiffness measurement (LSM) and platelet count, have been proposed to avoid unnecessary esophagogastroduodenoscopy (EGD) screening for esophageal varices needing treatment (EVNT). This approach has not been validated in PLWH | ||
| 520 | |a METHODS: PLWH from 8 prospective cohorts were included if they fulfilled the following criteria: (1) compensated advanced chronic liver disease (LSM >10 kPa); (2) availability of EGD within 6 months of reliable LSM. Baveno VI (LSM <20 kPa and platelets >150 000/μL), expanded Baveno VI (LSM <25 kPa and platelets >110 000/μL), and Estudio de las Hepatitis Víricas (HEPAVIR) criteria (LSM <21 kPa) were applied to identify patients not requiring EGD screening. Criteria optimization was based on the percentage of EGDs spared, while keeping the risk of missing EVNT <5% | ||
| 520 | |a RESULTS: Five hundred seven PLWH were divided into a training (n = 318) and a validation set (n = 189). EVNT were found in 7.5%. In the training set, Baveno VI, expanded Baveno VI, and HEPAVIR criteria spared 10.1%, 25.5%, and 28% of EGDs, while missing 0%, 1.2%, and 2.2% of EVNT, respectively. The best thresholds to rule out EVNT were platelets >110 000/μL and LSM <30 kPa (HIV cirrhosis criteria), with 34.6% of EGDs spared and 0% EVNT missed. In the validation set, HEPAVIR and HIV cirrhosis criteria spared 54% and 48.7% of EGDs, while missing 4.9% and 2.2% EVNT, respectively | ||
| 520 | |a CONCLUSIONS: Baveno VI criteria can be extended to HEPAVIR and HIV cirrhosis criteria while sparing a significant number of EGDs, thus improving resource utilization for PLWH with compensated advanced chronic liver disease | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Baveno VI criteria | |
| 650 | 4 | |a HCV coinfection | |
| 650 | 4 | |a esophagogastroduodenoscopy | |
| 650 | 4 | |a transient elastography | |
| 650 | 4 | |a variceal bleeding | |
| 700 | 1 | |a Saroli Palumbo, Chiara |e verfasserin |4 aut | |
| 700 | 1 | |a Mazzola, Giovanni |e verfasserin |4 aut | |
| 700 | 1 | |a Pineda, Juan A |e verfasserin |4 aut | |
| 700 | 1 | |a Téllez, Francisco |e verfasserin |4 aut | |
| 700 | 1 | |a Rivero-Juárez, Antonio |e verfasserin |4 aut | |
| 700 | 1 | |a Ríos-Villegas, Maria José |e verfasserin |4 aut | |
| 700 | 1 | |a Maurice, James B |e verfasserin |4 aut | |
| 700 | 1 | |a Westbrook, Rachel H |e verfasserin |4 aut | |
| 700 | 1 | |a Judge, Rebekah |e verfasserin |4 aut | |
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| 700 | 1 | |a Schepis, Filippo |e verfasserin |4 aut | |
| 700 | 1 | |a Perazzo, Hugo |e verfasserin |4 aut | |
| 700 | 1 | |a Rockstroh, Juergen |e verfasserin |4 aut | |
| 700 | 1 | |a Boesecke, Christoph |e verfasserin |4 aut | |
| 700 | 1 | |a Klein, Marina B |e verfasserin |4 aut | |
| 700 | 1 | |a Cervo, Adriana |e verfasserin |4 aut | |
| 700 | 1 | |a Ghali, Peter |e verfasserin |4 aut | |
| 700 | 1 | |a Wong, Philip |e verfasserin |4 aut | |
| 700 | 1 | |a Petta, Salvatore |e verfasserin |4 aut | |
| 700 | 1 | |a De Ledinghen, Victor |e verfasserin |4 aut | |
| 700 | 1 | |a Macías, Juan |e verfasserin |4 aut | |
| 700 | 1 | |a Sebastiani, Giada |e verfasserin |4 aut | |
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