Non-Invasive Prediction of Esophageal Varices After Antiviral Treatment: Analysis of a Long Term Follow-Up of 1605 Cases of Chronic Hepatitis C
AASLD LiverLearning®. Thandassery R. Nov 14, 2016; 144607
Dr. Ragesh Babu Thandassery
Dr. Ragesh Babu Thandassery
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TITLE: Non-Invasive Prediction of Esophageal Varices After Antiviral Treatment: Analysis of a Long Term Follow-Up of 1605 Cases of Chronic Hepatitis C

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In patients with chronic hepatitis C (CHC) who had completed antiviral therapy (AVT), we aim to 1) compare indirect non-invasive fibrosis scores (NIF), derived from routine pretreatment blood tests, for predicting the development of esophageal varices (EV) and 2) identify independent predictors for development of EV from routine pretreatment blood tests.
1605 patients (Jan 2002 to June 2014) with CHC received AVT with pegylated interferon and ribavirin.Twenty indirect NIFs were calculated from routine blood tests, prior to AVT. AUROCs were calculated for each of these NIF for development of EV after AVT.
Mean age was 41.9 ±9.7 years (85% males), predominantly genotypes 4(65%) and 1(11%). After AVT, there were 1,089(67.8%) responders, 482(30%) nonresponders and 34(2.1%) relapsers. After median follow-up of 6580.5 patient-years post AVT; 39 (2.4%) developed varices (2 patients had both esophageal and gastric varices and one had only gastric varices). Grade 1,2,3 and 4 EV were seen in 30,5,3 and 1 patients respectively. 52(3.2%) had decompensation (bleed-9, ascites-39, jaundice-22, hepatic encephalopathy-7, hepatorenal syndrome-4), 11(0.7%) had HCC.
Most of the NIFs showed high predictive accuracy for development of EV (table 1). The highest AUROCs were seen with FibroQ score (AUROC=0.968), FIB-4 score (AUROC=0.951) and Lok score (AUROC=0.930). On multivariate analysis of pretreatment blood parameters, GGT [Adjusted odds ratio (AOR) = 1.005, 95% confidence interval (CI) =1.002-1.008] and albumin (AOR=0.113, CI=0.037-0.351) were independent predictors for development of EV. Developed model [4.1 -2.1xalbumin(g/dl) + 0.005xGGT(U/L)], was able to discriminate 90% accurately between EV vs no EV cases (AUROC=0.90) having 88% sensitivity and 79% specificity
Routine pretreatment blood parameters like GGT and albumin and certain NIFs showed high accuracy for predicting development of EV post AVT in patients with CHC. Application of these simple scores may help in non-invasive screening of patients at high risk for esophageal varices.
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