Accuracy of non-invasive methods/models for predicting esophageal varices in patients with compensated advanced chronic liver disease secondary to nonalcoholic fatty liver disease
Autor(a) principal: | |
---|---|
Data de Publicação: | 2021 |
Outros Autores: | , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UFMG |
Texto Completo: | https://doi.org/10.1016/j.aohep.2020.07.003 http://hdl.handle.net/1843/51787 https://orcid.org/0000-0002-9776-4757 https://orcid.org/0000-0002-6641-1350 https://orcid.org/0000-0002-5443-7553 |
Resumo: | Introduction: Nonalcoholic fatty liver disease (NAFLD) patients can progress to cirrhosis. In these, there is a compensated stage in which esophageal varices can exist. However, no more than 20% of these patients have varices needing treatment (VNT). Objective: Evaluate the accuracy of non-invasive models to predict esophageal varices, as well as their performance to avoid esophagogastroduodenoscopy (EGD) with a risk of missing VNT of less than 5%, in Brazilian patients with compensated advanced chronic liver disease (cACLD) secondary to NAFLD. Methods: Twenty-one patients with biopsy-proven cACLD secondary to NAFLD were submitted to liver stiffness measurement (LSM) by transient elastography (TE), and data were collected to measure platelet count/spleen diameter ratio (PSR), LSM-spleen diameter to platelet ratio score (LSPS), varices risk score (VRS), Baveno VI, Expanded Baveno VI and NAFLD cirrhosis criteria. Results: The mean age was 61 (±6.6) years, and 81% were female; 14% presented VNT. For detection of VNT, LSPS and VRS performed excellently, with an area under receiver operating characteristic (AUROC) of 0.961 for both. LSM presented an AUROC of 0.889 and a cutoff point of 21.8 kPa. LSPS and VRS enabled sparing 75–80% of EGDs for VNT, with no risk of missing varices. Expanded Baveno VI enabled sparing 71% of EGDs, with 4.8% risk of missing VNT. Conclusion: LSPS and VRS performed excellently in both predicting VNT and sparing EGD, and Expanded Baveno VI showed good performance in sparing EGDs, with acceptable risk of missing VNT. An LSM cutoff point was established and had good performance. |
id |
UFMG_cf1fdf3d11c4164a67d52fb6fec2f9d4 |
---|---|
oai_identifier_str |
oai:repositorio.ufmg.br:1843/51787 |
network_acronym_str |
UFMG |
network_name_str |
Repositório Institucional da UFMG |
repository_id_str |
|
spelling |
2023-04-11T00:53:21Z2023-04-11T00:53:21Z202120https://doi.org/10.1016/j.aohep.2020.07.0031665-2681http://hdl.handle.net/1843/51787https://orcid.org/0000-0002-9776-4757https://orcid.org/0000-0002-6641-1350https://orcid.org/0000-0002-5443-7553Introduction: Nonalcoholic fatty liver disease (NAFLD) patients can progress to cirrhosis. In these, there is a compensated stage in which esophageal varices can exist. However, no more than 20% of these patients have varices needing treatment (VNT). Objective: Evaluate the accuracy of non-invasive models to predict esophageal varices, as well as their performance to avoid esophagogastroduodenoscopy (EGD) with a risk of missing VNT of less than 5%, in Brazilian patients with compensated advanced chronic liver disease (cACLD) secondary to NAFLD. Methods: Twenty-one patients with biopsy-proven cACLD secondary to NAFLD were submitted to liver stiffness measurement (LSM) by transient elastography (TE), and data were collected to measure platelet count/spleen diameter ratio (PSR), LSM-spleen diameter to platelet ratio score (LSPS), varices risk score (VRS), Baveno VI, Expanded Baveno VI and NAFLD cirrhosis criteria. Results: The mean age was 61 (±6.6) years, and 81% were female; 14% presented VNT. For detection of VNT, LSPS and VRS performed excellently, with an area under receiver operating characteristic (AUROC) of 0.961 for both. LSM presented an AUROC of 0.889 and a cutoff point of 21.8 kPa. LSPS and VRS enabled sparing 75–80% of EGDs for VNT, with no risk of missing varices. Expanded Baveno VI enabled sparing 71% of EGDs, with 4.8% risk of missing VNT. Conclusion: LSPS and VRS performed excellently in both predicting VNT and sparing EGD, and Expanded Baveno VI showed good performance in sparing EGDs, with acceptable risk of missing VNT. An LSM cutoff point was established and had good performance.Introdução: Pacientes com doença hepática gordurosa não alcoólica (DHGNA) podem evoluir para cirrose. Nestes, há um estágio compensado em que podem existir varizes esofágicas. No entanto, não mais do que 20% desses pacientes têm varizes que necessitam de tratamento (VNT). Objetivo: Avaliar a acurácia de modelos não invasivos para prever varizes esofágicas, bem como seu desempenho para evitar esofagogastroduodenoscopia (EGD) com risco de falha de VNT menor que 5%, em pacientes brasileiros com doença hepática crônica avançada compensada (cACLD) secundária à DHGNA. Métodos: Vinte e um pacientes com cACLD comprovada por biópsia secundária a NAFLD foram submetidos à medida da rigidez hepática (LSM) por elastografia transitória (TE), e os dados foram coletados para medir a relação contagem de plaquetas/diâmetro do baço (PSR), LSM-diâmetro do baço para pontuação de relação plaquetária (LSPS), pontuação de risco de varizes (VRS), Baveno VI, Baveno VI expandido e critérios de cirrose NAFLD. Resultados: A média de idade foi de 61 (±6,6) anos, sendo 81% do sexo feminino; 14% apresentaram VNT. Para detecção de VNT, LSPS e VRS tiveram excelente desempenho, com uma área sob característica de operação do receptor (AUROC) de 0,961 para ambos. O LSM apresentou AUROC de 0,889 e ponto de corte de 21,8 kPa. LSPS e VRS permitiram poupar 75-80% de EGDs para VNT, sem risco de perda de varizes. O Baveno VI expandido permitiu poupar 71% dos EGDs, com 4,8% de risco de perder VNT. Conclusão: LSPS e VRS tiveram excelente desempenho em prever VNT e poupar EGD, e Expanded Baveno VI mostrou bom desempenho em poupar EGDs, com risco aceitável de perder VNT. Um ponto de corte LSM foi estabelecido e teve bom desempenho.engUniversidade Federal de Minas GeraisUFMGBrasilHCL - HOSPITAL DAS CLINICASMED - DEPARTAMENTO DE CLÍNICA MÉDICAAnnals of HepatologyHepatopatia gordurosa não alcoólicaDoença hepática terminalVarizes esofágicas e gástricasHipertensão portalNAFLDcACLDEsophageal varicesLSMNon-invasive modelsAccuracy of non-invasive methods/models for predicting esophageal varices in patients with compensated advanced chronic liver disease secondary to nonalcoholic fatty liver diseasePrecisão de métodos/modelos não invasivos para prever varizes em pacientes com doença hepática crônica avançada compensada secundária a doença hepática gordurosa não alcoólicainfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articlesciencedirect.com/science/article/pii/S1665268120300764?via%3DihubHumberto Oliva GalizziClaudia Alves CoutoDaniela Oliveira de Lima TarantoSamuel I.O. AraújoEduardo Garcia Vilelaapplication/pdfinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFMGinstname:Universidade Federal de Minas Gerais (UFMG)instacron:UFMGLICENSELicense.txtLicense.txttext/plain; charset=utf-82042https://repositorio.ufmg.br/bitstream/1843/51787/1/License.txtfa505098d172de0bc8864fc1287ffe22MD51ORIGINALAccuracy of non-invasive methodsmodels for predicting esophageal varices in patients with compensated advanced chronic liver disease secondary to nonalcoholic fatty liver disease.pdfAccuracy of non-invasive methodsmodels for predicting esophageal varices in patients with compensated advanced chronic liver disease secondary to nonalcoholic fatty liver disease.pdfapplication/pdf814591https://repositorio.ufmg.br/bitstream/1843/51787/2/Accuracy%20of%20non-invasive%20methodsmodels%20for%20predicting%20esophageal%20varices%20in%20patients%20with%20compensated%20advanced%20chronic%20liver%20disease%20secondary%20to%20nonalcoholic%20fatty%20liver%20disease.pdfe948b42d149156db915d8c24b6c04f67MD521843/517872023-04-10 21:53:21.696oai:repositorio.ufmg.br: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Repositório de PublicaçõesPUBhttps://repositorio.ufmg.br/oaiopendoar:2023-04-11T00:53:21Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG)false |
dc.title.pt_BR.fl_str_mv |
Accuracy of non-invasive methods/models for predicting esophageal varices in patients with compensated advanced chronic liver disease secondary to nonalcoholic fatty liver disease |
dc.title.alternative.pt_BR.fl_str_mv |
Precisão de métodos/modelos não invasivos para prever varizes em pacientes com doença hepática crônica avançada compensada secundária a doença hepática gordurosa não alcoólica |
title |
Accuracy of non-invasive methods/models for predicting esophageal varices in patients with compensated advanced chronic liver disease secondary to nonalcoholic fatty liver disease |
spellingShingle |
Accuracy of non-invasive methods/models for predicting esophageal varices in patients with compensated advanced chronic liver disease secondary to nonalcoholic fatty liver disease Humberto Oliva Galizzi NAFLD cACLD Esophageal varices LSM Non-invasive models Hepatopatia gordurosa não alcoólica Doença hepática terminal Varizes esofágicas e gástricas Hipertensão portal |
title_short |
Accuracy of non-invasive methods/models for predicting esophageal varices in patients with compensated advanced chronic liver disease secondary to nonalcoholic fatty liver disease |
title_full |
Accuracy of non-invasive methods/models for predicting esophageal varices in patients with compensated advanced chronic liver disease secondary to nonalcoholic fatty liver disease |
title_fullStr |
Accuracy of non-invasive methods/models for predicting esophageal varices in patients with compensated advanced chronic liver disease secondary to nonalcoholic fatty liver disease |
title_full_unstemmed |
Accuracy of non-invasive methods/models for predicting esophageal varices in patients with compensated advanced chronic liver disease secondary to nonalcoholic fatty liver disease |
title_sort |
Accuracy of non-invasive methods/models for predicting esophageal varices in patients with compensated advanced chronic liver disease secondary to nonalcoholic fatty liver disease |
author |
Humberto Oliva Galizzi |
author_facet |
Humberto Oliva Galizzi Claudia Alves Couto Daniela Oliveira de Lima Taranto Samuel I.O. Araújo Eduardo Garcia Vilela |
author_role |
author |
author2 |
Claudia Alves Couto Daniela Oliveira de Lima Taranto Samuel I.O. Araújo Eduardo Garcia Vilela |
author2_role |
author author author author |
dc.contributor.author.fl_str_mv |
Humberto Oliva Galizzi Claudia Alves Couto Daniela Oliveira de Lima Taranto Samuel I.O. Araújo Eduardo Garcia Vilela |
dc.subject.por.fl_str_mv |
NAFLD cACLD Esophageal varices LSM Non-invasive models |
topic |
NAFLD cACLD Esophageal varices LSM Non-invasive models Hepatopatia gordurosa não alcoólica Doença hepática terminal Varizes esofágicas e gástricas Hipertensão portal |
dc.subject.other.pt_BR.fl_str_mv |
Hepatopatia gordurosa não alcoólica Doença hepática terminal Varizes esofágicas e gástricas Hipertensão portal |
description |
Introduction: Nonalcoholic fatty liver disease (NAFLD) patients can progress to cirrhosis. In these, there is a compensated stage in which esophageal varices can exist. However, no more than 20% of these patients have varices needing treatment (VNT). Objective: Evaluate the accuracy of non-invasive models to predict esophageal varices, as well as their performance to avoid esophagogastroduodenoscopy (EGD) with a risk of missing VNT of less than 5%, in Brazilian patients with compensated advanced chronic liver disease (cACLD) secondary to NAFLD. Methods: Twenty-one patients with biopsy-proven cACLD secondary to NAFLD were submitted to liver stiffness measurement (LSM) by transient elastography (TE), and data were collected to measure platelet count/spleen diameter ratio (PSR), LSM-spleen diameter to platelet ratio score (LSPS), varices risk score (VRS), Baveno VI, Expanded Baveno VI and NAFLD cirrhosis criteria. Results: The mean age was 61 (±6.6) years, and 81% were female; 14% presented VNT. For detection of VNT, LSPS and VRS performed excellently, with an area under receiver operating characteristic (AUROC) of 0.961 for both. LSM presented an AUROC of 0.889 and a cutoff point of 21.8 kPa. LSPS and VRS enabled sparing 75–80% of EGDs for VNT, with no risk of missing varices. Expanded Baveno VI enabled sparing 71% of EGDs, with 4.8% risk of missing VNT. Conclusion: LSPS and VRS performed excellently in both predicting VNT and sparing EGD, and Expanded Baveno VI showed good performance in sparing EGDs, with acceptable risk of missing VNT. An LSM cutoff point was established and had good performance. |
publishDate |
2021 |
dc.date.issued.fl_str_mv |
2021 |
dc.date.accessioned.fl_str_mv |
2023-04-11T00:53:21Z |
dc.date.available.fl_str_mv |
2023-04-11T00:53:21Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/1843/51787 |
dc.identifier.doi.pt_BR.fl_str_mv |
https://doi.org/10.1016/j.aohep.2020.07.003 |
dc.identifier.issn.pt_BR.fl_str_mv |
1665-2681 |
dc.identifier.orcid.pt_BR.fl_str_mv |
https://orcid.org/0000-0002-9776-4757 https://orcid.org/0000-0002-6641-1350 https://orcid.org/0000-0002-5443-7553 |
url |
https://doi.org/10.1016/j.aohep.2020.07.003 http://hdl.handle.net/1843/51787 https://orcid.org/0000-0002-9776-4757 https://orcid.org/0000-0002-6641-1350 https://orcid.org/0000-0002-5443-7553 |
identifier_str_mv |
1665-2681 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.ispartof.pt_BR.fl_str_mv |
Annals of Hepatology |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Universidade Federal de Minas Gerais |
dc.publisher.initials.fl_str_mv |
UFMG |
dc.publisher.country.fl_str_mv |
Brasil |
dc.publisher.department.fl_str_mv |
HCL - HOSPITAL DAS CLINICAS MED - DEPARTAMENTO DE CLÍNICA MÉDICA |
publisher.none.fl_str_mv |
Universidade Federal de Minas Gerais |
dc.source.none.fl_str_mv |
reponame:Repositório Institucional da UFMG instname:Universidade Federal de Minas Gerais (UFMG) instacron:UFMG |
instname_str |
Universidade Federal de Minas Gerais (UFMG) |
instacron_str |
UFMG |
institution |
UFMG |
reponame_str |
Repositório Institucional da UFMG |
collection |
Repositório Institucional da UFMG |
bitstream.url.fl_str_mv |
https://repositorio.ufmg.br/bitstream/1843/51787/1/License.txt https://repositorio.ufmg.br/bitstream/1843/51787/2/Accuracy%20of%20non-invasive%20methodsmodels%20for%20predicting%20esophageal%20varices%20in%20patients%20with%20compensated%20advanced%20chronic%20liver%20disease%20secondary%20to%20nonalcoholic%20fatty%20liver%20disease.pdf |
bitstream.checksum.fl_str_mv |
fa505098d172de0bc8864fc1287ffe22 e948b42d149156db915d8c24b6c04f67 |
bitstream.checksumAlgorithm.fl_str_mv |
MD5 MD5 |
repository.name.fl_str_mv |
Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG) |
repository.mail.fl_str_mv |
|
_version_ |
1803589256251179008 |