Transcript Titel Autor Ort, Datum - XVIII International AIDS

WEPDB 202:
Evaluation of risk for esophageal
varices by transient elastometry in
patients with HIV and HCV infection
and liver cirrhosis
M.K. Mausolf1, M. Berger1, J. Breitkreutz1, J. Hartikainen1, U. Joppek1, H. Schulbin1, H.
Stocker1, C. Traeder1, C. Weber1, T. Weipert1, K. Arastéh1, R. Weiss2, P. Ingiliz1
Institute(s): 1Vivantes Auguste-Viktoria-Klinikum Berlin, Gastroenterology and Infectious Diseases, Berlin, Germany,
2Hematology and Infectious Diseases, Bremen, Germany
Transient elastometry as a tool to predict complications of cirrhosis?
Complications of cirrhosis
12
16
EV = 0
27
49
54
63
EV grade 2 or 3
EAD
HCC
REV
Chanteloup et al. AASLD Boston 2004
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75
kPa
Baseline characteristics of patients with Fibroscan >12.5 kPa1 and UGI (n=68)
Varices (n=17)
No varices (n=51)
49 (36-70)
47 (28-66)
14 (82)
35 (68)
Median BMI [kg/m2] (95%-CI)
24.5 (22-27)
23 (22-26)
Median ALT level [IU/mL]
(95%-CI)
69 (59-128)
66 (65-141)
Median GGT level [IU/mL]
(95%-CI)
72 (59-137)
110 (139-365)
Median bilirubin level [mg/dL]
(95%-CI)
0.95 (0.51-2.45)
0.73 (0.81-1.47)
Median prothrombin time [%]
(95%-CI)
73 (63-82)
89 (83-96)
HCV monoinfection [No. (%)]
6 (35)
14 (27)
HIV-HCV coinfection [No.
(%)]
7 (41)
24 (47)
Miscellanous [No. (%)]
4 (24)
13 (26)
Mean liver stiffness in kPa
(+/- SD)
43 (21)
28 (19)
36 (32-54)
19 (23-34)
Age, median years (range)
Male sex [No. (%)]
P
0.01
0.005
Indication
Median liver stiffness in kPa
(95%-CI)
1Castera
L, et al. Gastroenterology 2005;128:343–350
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<0.01
Significantly higher stiffness values in patients with varices
36
p<0.01
19
Esophageal varices
No varices
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Are values >36 kPa predictive for the presence of varices?
Sensitivity
Specificity
PPV
NPV
47%
75%
0.38
0.81
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Are values <19 kPa predictive for the absence of varices?
Sensitivity
Specificity
PPV
NPV
51%
94%
0.96
0.39
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Conclusions
• In cirrhotic patients (stiffness >12.5 kPa) transient
elastometry indicates the presence of esophageal varices
by higher values („the higher, the stiffer“)
• HCV infected and HIV/HCV coinfected patients with
esophageal varices had median stiffness values of 36 kPa
• Fibroscan cannot replace gastroscopy for the diagnosis of
varices
• Stiffness values <19 kPa strongly indicate the absence of
esophageal varices
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Thank you for your attention!
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back-up slides
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ROC curve
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