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Abstract
Background Portal hypertension (PH) remains an important sequela of cirrhosis, contributing to morbidity and mortality. Non-invasive algorithms identifying patients at risk of clinically significant portal hypertension (CSPH) and high-risk gastro-oesophageal varices (varices needing treatment, VNT) are critical. We previously described an algorithm whereby liver stiffness measurement (LSM) ≤25 kPa plus platelets ≥100 excluded VNT in Child-Pugh A cirrhosis. 5 years following the inception of our initial study, this study aimed to assess the prognostic value of LSM ≤25 kPa plus platelets ≥100 in predicting long-term hepatic decompensation and death.
Methods This is a retrospective multicentre study of patients from two tertiary centres. Medical records were reviewed for all subsequent gastroscopies, LSM, six-monthly laboratory tests and abdominal ultrasounds, symptoms/signs consistent with hepatic decompensation (ascites, variceal bleeding, hepatic encephalopathy), and mortality from the initial study date. Patients with an LSM >25 kPa plus platelets <100 were considered high risk for VNT, while patients with LSM ≤25 kPa and/or platelets ≥100 were considered low risk.
Results 180 patients were included. Median age was 55 yrs (IQR 49-63), 70% male, with no significant difference between groups. Median follow-up was 7.7 yrs (4.5-9.0). At study inception, 30/180 (17%) were high risk. The majority (114/180, 63%) had cirrhosis secondary to HCV, similar according to risk group (p=0.752). Decompensation was significantly more common in high-risk patients (11/30 (37%) vs 26/150 (17%) respectively, p=0.016; (IDDF2021-ABS-0056 Figure 1. Decompensation according to high-risk and low-risk category)). 2/150 (1%) low-risk patients were re-classified as high-risk. 19/150 (13%) of low-risk patients had VNT compared to 7/30 (23%) in the high-risk group (p=0.043). There was a trend towards higher mortality in high-risk vs low-risk patients (12/30 (40%) vs 36/150 (24%), respectively, p=0.067; (IDDF2021-ABS-0056 Figure 2. Death according to high-risk and low-risk category)).
Conclusions Our previously defined algorithm of LSM and platelets has prognostic value in predicting for subsequent decompensation and death. LSM+PLT can assist in stratifying future risk of liver-related events in Child-Pugh A cirrhotics.