A55 PREDICTORS OF ENDOSCOPIC HIGH RISK ESOPHAGEAL VARICES IN COMPENSATED CIRRHOSIS: CAN WE AVOID FIBROSCAN?
Bibliographic record
Abstract
Patients with cirrhosis are at risk of developing esophageal varices (EV). Recently, criteria based on elastography and platelet count (Baveno VI criteria) have been adopted and included in practice guidelines to circumvent screening endoscopy (EGD). However, elastography measurement is not widely available. The aim of the study was to determine predictive factors excluding liver stiffness in order to predict high-risk EV in patients with compensated cirrhosis. Retrospective chart review of all compensated cirrhotic adult patients who underwent screening EGD at Saint-Luc Hospital between 01/2014 and 12/2016. Patients with decompensated cirrhosis (ascites, hepatic encephalopathy, jaundice), past history of EV/TIPS or liver transplantation, acute upper gastointestinal bleeding, acute alcoholic hepatitis were excluded. High-risk EV were defined as medium or large EV and/or presence of red wale signs. Splenomegaly was defined as a spleen ≥ 13 cm on imaging. Thrombopenia was defined as a platelet count < 150 x 109/L. Baseline characteristics, laboratory values and EGD findings were analyzed. A total of 463 patients were included. The median (IQR) age was 60.2 (13.4) years and the majority were males (n=289; 62.4%). The most frequent causes of liver disease were chronic hepatitis C infection (n=117; 25.3%) and non-alcoholic steatohepatitis (n=112; 24.2%). At screening EGD, the median (IQR) MELD score was 7.5 (2.7), the median (IQR) platelet count was 154 (87) x 109/L, and 203 (43.8%) patients had splenomegaly. A total of 45 (9.7%) patients had high-risk EV at screening EGD. In multivariate analysis adjusting for age and gender, the following variables were predictive of high-risk EV: thrombopenia (OR 4.7; p= 0.001) and splenomegaly (OR 3.8; p=0.001). MELD > 6 score was not predictive of high-risk EV (OR 1.7; p=0.337). Among the 172 patients having normal spleen size and platelet count ≥ 150 x 109, only 2 (1.2%) patients had high-risk EV at screening EGD. The presence of splenomegaly and/or thrombopenia had a sensitivity of 95.6% and a negative predictive value of 98.8% for the presence of high-risk EV at screening endoscopy. In compensated cirrhosis, the combination of normal spleen size and normal platelet count translates into a 98.8% chance of absence of high-risk EV at screening EGD. Using these criteria, 172 (37.1%) screening EGD could have been avoided in our population. Therefore, the use of elastography is not mandatory in the decision of recommending screening EGD in patients with compensated cirrhosis. None
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".