Abstract

Background: Clinically significant portal hypertension (CSPH) is a major prognostic factor in patients with hepatocellular carcinoma (HCC) complicated by cirrhosis, influencing both survival and treatment outcomes. Esophageal variceal hemorrhage, a severe complication of CSPH, is associated with a poor prognosis. The gold standard for diagnosing CSPH  involves invasive procedures like hepatic venous pressure gradient (HVPG) measurement; however, these methods are not always feasible in clinical practice. The Baveno VII consensus recommends non-invasive strategies for variceal screening, but their applicability in HCC patients remains uncertain due to the potential confounding effects of HCC on liver stiffness measurements (LSM). This study explores the use of the ALBI-PLT score, which combines the albumin-bilirubin (ALBI) grade and platelet count, as a non-invasive alternative for predicting varices in HCC patients with compensated cirrhosis.
Objectives: The primary objectives were to determine the prevalence and risk factors of varices in HCC patients, validate the predictive ability of the ALBI-PLT score for variceal screening in compensated cirrhosis, and identify a subgroup of patients who could safely forgo endoscopic variceal screening.
Methods: This single-center, retrospective, observational study was conducted at the Department of Gastroenterology and Hepatology, Habib Bougatfa University Hospital, Tunisia, over six months (July 2024 - January 2025). A total of 50 patients with cirrhosis complicated by HCC were included. The ALBI score, ALBI grade, and ALBI-PLT score were calculated, and esophageal varices were assessed by esophagogastroduodenoscopy (EGD). The exclusion criteria were as follows: (1) patients with incomplete information regarding HCC etiology, CTP score, cancer stage, treatment, or mortality, (2) patients who did not undergo endoscopic screening of esophageal varices within three months of HCC diagnosis, (3) patients who had undergone splenectomy or partial splenic arterial embolization, as these interventions could affect the ALBI-PLT score, and (4) decompensated patients, defined as those with ascites, varices, hepatic encephalopathy, jaundice, or a CTP score >6. Statistical analysis was performed using SPSS v26, with p-values ≤ 0.05 considered statistically significant.
Results: The cohort had a mean age of 67.5 ± 12.20 years, with a male predominance (62%). Hepatitis C was the leading etiology (44%). Esophageal varices were present in 82% of patients, with 18% having no varices, 4% with grade I, 44% with grade II, and 34% with grade III varices. Patients with higher ALBI-PLT scores were significantly more likely to present with high-risk varices, highlighting a strong link between worsening score and variceal severity. Diagnostic performance was strong, with the score achieving an area under the ROC curve of 0.908. A cutoff value of ≥1.5 best discriminated risk groups, offering both perfect sensitivity and high specificity. At this threshold, patients scoring below 1.5 were very unlikely to harbor high-risk varices and could potentially avoid unnecessary endoscopic screening. Multivariate analysis confirmed the ALBI-PLT score as an independent predictor of high-risk varices.
Conclusion: The ALBI-PLT score demonstrated promising diagnostic accuracy for stratifying variceal risk in compensated HCC. A score <1.5 reliably excluded HRV, suggesting that routine EGD may be avoided in this subgroup. However, given the single-center, retrospective design and modest sample size, these findings require validation in larger, multicenter cohorts before clinical application.”

Keywords

ALBI score, ALBI grade, ALBI-PLT score, Hepatocellular carcinoma, gastroesophageal varices, endoscopy