ALBI-Platelets Score and Transient Elastography Combination as Predictor Factor of High-Risk Varices in Egyptian Patients with Compensated Hepatocellular Carcinoma

Background and study aim: Hepatocellular carcinoma (HCC) is associated with increased portal pressure; however, variceal screening guidelines are based on cirrhotic patients without HCC, underscoring the need for HCC-specific strategies. Our study aims to evaluate the combination of albumin-bilirubin grade and platelet count (ALBI-PLT score) with Transient Elastography in predicting the presence of high-risk varices (HRVs) in compensated HCC patients.Patients and Methods: The study prospectively enrolled 220 participants: 160 patients with newly diagnosed hepatocellular carcinoma (HCC) and compensated liver cirrhosis (Child-Pugh A, score 5–6), and 60 control patients with compensated cirrhosis (Child-Pugh A, score 5–6) without HCC.Participants were recruited from the HCC and outpatient clinics at the National Liver Institute, Menoufia University.Results: There was a significant difference between patients with HRVs and those without HRVs regarding the albumin/bilirubin-platelet (ALBI-PLT) score. An ALBI-PLT score of 2 showed a sensitivity of 97.9% and specificity of 40.5%, while a score of 3 had a sensitivity of 74.5% and specificity of 35%, and a score of 4 showed a sensitivity of 72% and specificity of 74%, all with significant predictive value for HRV. Additionally, Liver stiffness measurement (LSM) demonstrated a sensitivity of 70% and specificity of 62% for predicting HRV. Using an LSM cut-off of 25 kPa combined with the ALBI-PLT score resulted in a sensitivity of 95% and specificity of 52.4%, also significantly predicting HRV.Conclusion: Combining the ALBI-PLT score with LSM provides a sensitive, non-invasive method to predict high-risk varices in compensated HCC patients, potentially limiting unnecessary endoscopy.