Gut Liver.  2019 Mar;13(2):206-214. 10.5009/gnl18292.

Multicenter Retrospective Risk Assessment of Esophageal Variceal Bleeding in Patients with Cirrhosis: An Acoustic Radiation Force Impulse Elastography-Based Prediction Model

• Heo JY
• Kim BK
• Park JY
• Kim DY
• Ahn SH
• Tak WY
• Kweon YO
• Han KH
• Park SY
• Kim SU

• KMID: 2446806
• DOI: http://doi.org/10.5009/gnl18292

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.

Keyword

Acoustic radiation force impulse; Esophageal varix; Liver cirrhosis

MeSH Terms

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