title: Noninvasive tools and risk of clinically significant portal hypertension and varices in compensated cirrhosis: The "Anticipate" study.
abstract: In patients with compensated advanced chronic liver disease (cACLD), the presence of clinically significant portal hypertension (CSPH) and varices needing treatment (VNT) bears prognostic and therapeutic implications. Our aim was to develop noninvasive tests-based risk prediction models to provide a point-of-care risk assessment of cACLD patients. We analyzed 518 patients with cACLD from five centers in Europe/Canada with paired noninvasive tests (liver stiffness measurement [LSM] by transient elastography, platelet count, and spleen diameter with calculation of liver stiffness to spleen/platelet score [LSPS] score and platelet-spleen ratio [PSR]) and endoscopy/hepatic venous pressure gradient measurement. Risk of CSPH, varices, and VNT was modeled with logistic regression. All noninvasive tests reliably identified patients with high risk of CSPH, and LSPS had the highest discrimination. LSPS values above 2.65 were associated with risks of CSPH above 80%. None of the tests identified patients with very low risk of all-size varices, but both LSPS and a model combining TE and platelet count identified patients with very low risk (<5%) risk of VNT, suggesting that they could be used to triage patients requiring screening endoscopy. LSPS values of <1.33 were associated with a <5% risk of VNT, and 26% of patients had values below this threshold. LSM combined with platelet count predicted a risk <5% of VNT in 30% of the patients. Nomograms were developed to facilitate point-of-care risk assessment.
  
  
  
  A significant proportion of patients with a very high risk of CSPH, and a population with a very low risk of VNT can be identified with simple, noninvasive tests, suggesting that these can be used to individualize medical care. (Hepatology 2016;64:2173-2184).
authors.affiliation: Cirrhosis Care Clinic, Division of Gastroenterology (Liver Unit), University of Alberta, CEGIIR, Edmonton, Alberta, Canada.
authors.forename: Juan G
authors.initials: JG
authors.lastname: Abraldes
authors.affiliation: Service d'hépato-gastroentérologie Hôpital Purpan CHU Toulouse, Toulouse France et Université Paul Sabatier, Toulouse, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Bureau
authors.affiliation: Hepatology Unit, Regional Institute of Gastroenterology and Hepatology "Octavian Fodor"; University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania.
authors.forename: Horia
authors.initials: H
authors.lastname: Stefanescu
authors.affiliation: Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Institut de Recerca Vall d'Hebron (VHIR), Universitat Autònoma de Barcelona, CIBEREHD, Barcelona, Spain.
authors.forename: Salvador
authors.initials: S
authors.lastname: Augustin
authors.affiliation: Cirrhosis Care Clinic, Division of Gastroenterology (Liver Unit), University of Alberta, CEGIIR, Edmonton, Alberta, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Ney
authors.affiliation: Service d'hépato-gastroentérologie Hôpital Purpan CHU Toulouse, Toulouse France et Université Paul Sabatier, Toulouse, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Blasco
authors.affiliation: Hepatology Unit, Regional Institute of Gastroenterology and Hepatology "Octavian Fodor"; University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania.|Hepatic Hemodynamic Lab, Liver Unit, Hospital Clinic, University of Barcelona, CIBEREHD, Barcelona, Spain.
authors.forename: Bogdan
authors.initials: B
authors.lastname: Procopet
authors.affiliation: Hepatic Hemodynamic Lab, Liver Unit, Hospital Clinic, University of Barcelona, CIBEREHD, Barcelona, Spain.|Hepatology, Swiss Liver Center, Universitätsklinik für Viszerale Chirurgie und Medizin (UVCM), Inselspital, University of Bern, Switzerland.
authors.forename: Jaime
authors.initials: J
authors.lastname: Bosch
authors.affiliation: Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Institut de Recerca Vall d'Hebron (VHIR), Universitat Autònoma de Barcelona, CIBEREHD, Barcelona, Spain.
authors.forename: Joan
authors.identifier: 0000-0002-0831-8422
authors.initials: J
authors.lastname: Genesca
authors.affiliation: Hepatic Hemodynamic Lab, Liver Unit, Hospital Clinic, University of Barcelona, CIBEREHD, Barcelona, Spain.|Hepatology, Swiss Liver Center, Universitätsklinik für Viszerale Chirurgie und Medizin (UVCM), Inselspital, University of Bern, Switzerland.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Berzigotti
mesh_terms: D003430:Cross-Sectional Studies; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis* / Q000209:etiology; D008103:Liver Cirrhosis / Q000150:complications; D008875:Middle Aged; D019095:Point-of-Care Systems; D012189:Retrospective Studies; D018570:Risk Assessment; D014648:Varicose Veins / Q000175:diagnosis* / Q000209:etiology