Title Novel albumin, bilirubin and platelet criteria for the exclusion of high-risk varices in compensated advanced chronic liver disease: A validation study.
Author Wong, Yu Jun; Kew, Guan Sen; Tan, Poh Seng; Chen, Zhaojin; Putera, Martin; Yip, Wenjun Alexander; Ang, Tiing Leong; Fock, Kwong Ming; Lee, Guan Huei; Hsiang, John; Huang, Daniel Q; Kwek, Andrew; Muthiah, Mark D; Kumar, Rahul; Tan, Malcolm; Tan, Jessica; Thurairajah, Prem Harichander; Teo, Eng Kiong; Tai, Bee Choo; Lim, Seng Gee
Journal Clin Res Hepatol Gastroenterol Publication Year/Month 2021-Nov
PMID 33780835 PMCID -N/A-
Affiliation + expend 1.Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore. Electronic address: eugene.wong.y.j@singhealth.com.sg.

BACKGROUND AND AIMS: Availability of transient elastography (TE) limits the application of Baveno-VI criteria. In a derivation study, the ABP criteria (Albumin >40鈥痝/l, Bilirubin <22鈥痬umol/l and Platelet >114,000/mul) had been shown to perform well in identifying compensated advanced chronic liver disease (cACLD) patients without high-risk varices (HRV). We aim to externally validate this novel ABP criteria for the exclusion of HRVs among cACLD patients. METHODS: Data was retrospectively collected from consecutive cACLD patients with paired TE and esophagogastroduodenoscopy (EGD) performed between 2011 and 2017 in Changi General Hospital, Singapore. We estimate the discriminative ability of ABP criteria in validation cohort using AUROC and calibration-in-the-large. We subsequently compare the performance between ABP and Baveno-VI criteria in the validation cohort. RESULTS: Among 314 patients included in our validation cohort, 32 (10.2%) had HRV on screening EGD. Application of ABP criteria within this validation cohort has increased discriminative ability than the derivation cohort. The AUROC of validation and derivation cohort were 0.68 (0.60-0.76) and 0.66 (0.60-0.76), respectively. The mean and standard error for calibration-in-the-large and calibration slope were -0.08 (0.22) and 0.93 (0.26) respectively. The ABP criteria had excellent performance in excluding HRV and will spare more screening EGDs than the Baveno-VI criteria (39.2% vs 27.4%, p鈥?鈥?.001), without missing more HRVs. CONCLUSION: We validated the performance of ABP criteria for the exclusion of HRVs in cACLD patients. ABP criteria is superior to Baveno-VI criteria by sparing more screening EGD without the need of TE.

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