Noninvasive Assessment of Portal Hypertension in Patients With Primary Biliary Cholangitis Is Affected by Severity of Cholestasis
Year: 2024
Type: article
Study design: Observational Study
Abstract: BACKGROUND & AIMS: Noninvasive tests (NITs) for ruling-out clinical significant portal hypertension (CSPH) and high-risk varices (HRVs) in patients with primary biliary cholangitis (PBC) and compensated advanced chronic liver disease (cACLD) are lacking. We evaluated NITs in these patients and the influence of cholestasis on their performance. METHODS: Consecutive patients from the "Italian PBC registry" and 2 United Kingdom large-volume PBC referral centers with upper endoscopy within 6 months from biochemical evaluation and transient elastography were included. Rete Sicilia Selezione Terapia (RESIST), Baveno VI (BVI), and Expanded Baveno VI (EBVI) criteria for ruling out HRV were assessed according to alkaline phosphatase (ALP) levels (< or ≥1.5 × upper limit of normal). Decision curve analysis was performed. Prevalence of any sized esophageal varices among patients fitting Baveno VII (BVII) criteria was also calculated. RESULTS: The final cohort consisted of 293 patients with cACLD. RESIST criteria were associated with the lowest rate of missed HRV (2.5% vs 9.8% for BVI and 8.9% for EBVI). In patients with ALP levels ≥1.5 × upper limit of normal, BVI and EBVI missed a higher rate of HRV (15.5% and 14.5%, respectively) than RESIST (3.1%). Decision curve analysis demonstrated the highest net benefit of RESIST criteria for ruling out HRV, regardless of ALP levels. Among 75 patients classified as low risk of CSPH according to BVII, 14 (18.7%) showed esophageal varices. CONCLUSIONS: Biochemical-based RESIST criteria demonstrate the highest net benefit compared with elastography-based criteria for ruling out HRV. The severity of cholestasis affects NITs performance to rule out HRV and CSPH in patients with PBC and cACLD.
Authors: Vincenza Calvaruso, Ciro Celsa, Laura Cristoferi, Miki Scaravaglio, Rachel Smith, Senamjit Kaur, Gabriele Di Maria, Luigi Capodicasa, Grazia Pennisi, Alessio Gerussi, Eugenia Nofit, Federica Malinverno, Pietro Lampertico, Nora Cazzagon, Marco Marzioni, Umberto Vespasiani-Gentilucci, Francesca Colapietro, Pietro Andreone, Ana Lleo, Cristina Rigamonti, Mauro Viganò, Edoardo Giovanni Giannini, Maurizio Russello, Ester Vanni, Federica Cerini, Alessandra Orlandini, Maurizia Brunetto, Grazia Anna Niro, Giovanni Vettori, Antonino Castellaneta, Vincenzo Cardinale, Domenico Alvaro, Andrea Mega, Valeria Pace Palitti, Valentina Cossiga, Filomena Morisco, Francesco Bellanti, Leonardo Baiocchi, Luca Fabris, Marcello Persico, Elisabetta Degasperi, Sara Labanca, Emanuela Bonaiuto, Francesco Pezzato, Alessandro Federico, Salvatore Petta, Vito Di Marco, George F. Mells, Emma Culver, Pietro Invernizzi, Calogero Cammà, Marco Carbone
Institutions: University of Palermo, Azienda Ospedaliera San Gerardo, University of Milano-Bicocca, Cambridge University Hospitals NHS Foundation Trust, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Trust, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Padua, Marche Polytechnic University, Università Campus Bio-Medico, Campus Bio Medico University Hospital, Humanitas University, University of Modena and Reggio Emilia, IRCCS Humanitas Research Hospital, Università degli Studi del Piemonte Orientale “Amedeo Avogadro”, Azienda Ospedaliero Universitaria Maggiore della Carita, Ospedale Papa Giovanni XXIII, Ospedale Policlinico San Martino, University of Genoa, Ospedale Garibaldi, Azienda Ospedaliera Citta' della Salute e della Scienza di Torino, University of Turin, Ospedale San Giuseppe, University of Parma, Ospedale di Parma, University of Pisa, Azienda Ospedaliera Universitaria Pisana, Casa Sollievo della Sofferenza, Ospedale Santa Chiara, Provincia Autonoma di Trento, University of Bari Aldo Moro, Sapienza University of Rome, Ospedale di Bolzano, Provincia autonoma di Bolzano - Alto Adige, Federico II University Hospital, University of Naples Federico II, University of Foggia, University of Rome Tor Vergata, Azienda Ospedale - Università Padova, University of Salerno, University of Campania "Luigi Vanvitelli"
Language: English
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,050
OpenAlex ID: W4405381202