The Combination of Shear Wave Elastography and Platelet Counts Can Effectively Predict High-Risk Varices in Patients with Hepatitis B-Related Cirrhosis

Abstract

Background. Baveno VI criteria, based on liver stiffness (LS) measured by transient elastography and platelet counts (PLT), have been proposed to avoid unnecessary endoscopy screening for high-risk varices (HRVs). However, the cut-off value of LS measured by 2D-SWE and PLT to predict HRVs in compensated hepatitis B-related cirrhotic patients remains unknown. Aims. To prospectively analyze the cut-off of the combination of LS measured by 2D-SWE and PLT in predicting HRVs and the influence of antiviral therapies in its efficacy. Methods. Serum parameters, LS, and endoscopy results were obtained from 160 compensated hepatitis B-related cirrhotic patients. The accuracy of the combined algorithm was assessed in the whole cohort and subgroups with or without consecutive antiviral therapies in the past 6 months. Results. In the whole cohort, the optimal cut-off value of LS for HRVs was 14.5 kPa. Patients with a $\text{LS}\text{value}<14.5\text{kPa}$ with a $\text{PLT}\text{value}>110\times {10}^9/\text{L}$ can be excluded from HRVs ( $\text{NPV}=0.99$ , $\text{endoscopy}\text{saved}\text{rates}=0.68$ ). Conversely, a LS value of ≥14.5 kPa and a PLT value of $\le 110\times {10}^9/\text{L}$ indicated HRVs, with accurate rates of 82.35%, and 10.63% of patients can avoid additional endoscopy screening. Moreover, antiviral therapy had no significant effect on the accuracy and rates saved from further endoscopy screening, when comparing patients with or without antiviral therapies (all $p$ values > 0.05). Conclusions. The combination of LS (14.5 kPa) measured by 2D-SWE and PLT ( $110\times {10}^9/\text{L}$ ) can predict HRVs accurately in compensated hepatitis B-related cirrhotic patients without significant interference of antiviral therapy histories.