Baveno VII algorithm outperformed other models in ruling out high-risk varices in individuals with HBV-related cirrhosis

Zhang, Xiaofeng; Song, Jiankang; Zhang, Hongjie; Wen, Biao; Dai, Letian; Xi, Ranran; Wu, Qiaoping; Li, Yuan; Luo, Xin; Lan, Xiaoqin; He, Qinjun; Luo, Wenfan; Lai, Qintao; Ji, Yali; Zhou, Ling; Qi, Tingting; Liu, Miaoxia; Zhou, Fuyuan; Wen, Weiqun; Li, Hui; Liu, Zhihua; Chen, Yongpeng; Zhu, Yi; Li, Junying; Huang, Jing; Cheng, Xiao; Tu, Minghan; Hou, Jinlin; Li, Ang; Chen, Jinjun

doi:10.1016/j.jhep.2022.10.030

Cited by 18 publications

(28 citation statements)

References 29 publications

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“…First, only commonly used parameters were assessed in our cohorts. We could not validate the use of von Willebrand factor antigen (VITRO score), 21 or spleen diameter (spleen diameter to platelet ratio or LSM‐longitudinal spleen diameter to platelet ratio) for the prediction of decompensation in patients of Baveno VII grey zone 22 . Second, the definition of cACLD was based on LSM which might be confounded by obesity, liver congestion or operator experience 23 .…”

Section: Discussionmentioning

confidence: 99%

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Risk and predictors of hepatic decompensation in grey zone patients by the Baveno VII criteria: A competing risk analysis

Lin,

Lai,

Wong

et al. 2023

Aliment Pharmacol Ther

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SummaryBackgroundBaveno VII was proposed for non‐invasive identification of clinically significant portal hypertension. However, a substantial proportion of patients is classified in the grey zone (i.e., liver stiffness 15–24.9 kPa and/or platelet count <150 × 109/L).AimsTo evaluate the risk and predictors of hepatic decompensation in patients in the grey zone, and to determine the prognostic role of spleen stiffness measurement.MethodsWe included prospective cohorts (from Hong Kong, Korea and France) of patients who had undergone transient elastography examination for chronic liver disease. We estimated risk of hepatic decompensation using competing risk regression with hepatocellular carcinoma and non‐liver‐related death as competing events.ResultsWe identified 2763 patients with compensated advanced chronic liver disease (cACLD). There were 1243 (44.9%) and 536 (19.4%) patients in the Baveno VII grey zone and high‐risk groups, respectively. The cumulative incidence of decompensation at 5 years was significantly different among low‐risk (0.6% [95% CI: 0.2%–1.3%]), grey zone 4.2% (95% CI: 3.1%–5.4%) and high‐risk groups (11.4% [95% CI: 8.7%–14.6%]). By competing risk analysis, aetiology of liver disease (alcohol‐related liver disease), albumin–bilirubin score and alkaline phosphatase level were independently associated with decompensation among patients in the grey zone. The combination of Baveno VII and spleen stiffness significantly reduced patients classified into grey zone (12.8% in cACLD patients), while maintaining high discrimination of decompensation in low‐ and high‐risk groups.ConclusionsPatients in grey zone of Baveno VII criteria remain at high risk of hepatic decompensation. Clinical risk factors and spleen stiffness can further stratify the risk in such patients.

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Section: Discussionmentioning

confidence: 99%

“…tion of decompensation in patients of Baveno VII grey zone 22. Second, the definition of cACLD was based on LSM which might be confounded by obesity, liver congestion or operator experience 23.…”

mentioning

confidence: 99%

Risk and predictors of hepatic decompensation in grey zone patients by the Baveno VII criteria: A competing risk analysis

Lin,

Lai,

Wong

et al. 2023

Aliment Pharmacol Ther

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“…37 There are only a few studies evaluating the accuracy of the 100-Hz probe for SSM for the diagnosis of CSPH and HRV. 38,39 A Chinese study evaluated Baveno VII algorithm with the 100-Hz probe to rule out HRV in HBV cirrhotic patients and found better performance of the spleen-dedicated probe, with more spared EGDs and a sensitivity of 97.0% and negative predictive value of 99.4%. 39 Our study population included only cirrhotic patients (mainly from alcoholic liver disease and NAFLD), and all patients underwent EGD, LSM, and SSM.…”

Section: Discussionmentioning

confidence: 99%

“…38,39 A Chinese study evaluated Baveno VII algorithm with the 100-Hz probe to rule out HRV in HBV cirrhotic patients and found better performance of the spleen-dedicated probe, with more spared EGDs and a sensitivity of 97.0% and negative predictive value of 99.4%. 39 Our study population included only cirrhotic patients (mainly from alcoholic liver disease and NAFLD), and all patients underwent EGD, LSM, and SSM. LSM showed only fair capacity to predict the presence of HRV (AUC 0.707), while SSM demonstrated an excellent capacity to predict the presence of HRV (AUC 0.934).…”

Section: Discussionmentioning

confidence: 99%

Spleen stiffness: a new tool to predict high‐risk varices in cirrhotic patients

Gaspar,

Silva,

Cardoso

et al. 2023

J of Gastro and Hepatol

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IntroductionCirrhosis is one of the major causes of morbidity and mortality worldwide. Portal hypertension is the major contributor of cirrhosis‐related complications and is defined as a hepatic venous pressure gradient (HVPG) > 5 mmHg. Measurement of HVPG is an invasive, difficult, and costly procedure. Therefore, it is only performed in specialized centers. Liver stiffness measured with transient elastography is one of the most studied noninvasive markers of portal hypertension, and spleen elastography has recently emerged as an important adjuvant tool. The development of a new probe (100 Hz) that more reliably reflect the grade of portal hypertension evaluated by spleen stiffness measurement has improved the accuracy of this technique. The aim of this work was to evaluate the accuracy of spleen stiffness with the new dedicated probe to predict the presence of high‐risk varices, as well as to determine the ideal cutoff to predict it.MethodsProspective study of cirrhotic patients admitted to upper endoscopy that were also submitted to liver and spleen elastography with the 100‐Hz probe by the same blinded operator in a tertiary center.ResultsWe included 209 cirrhotic patients, with mean age of 61.9 years (±9.9), 77.0% male. The most common etiology was alcoholic liver disease (72.7%). The median value of liver elastography was 25.3 [4.5–75] kPa, and the median value of spleen elastography was 42.4 [7.6–100] kPa. At the cutoff of 53.25 kPa, we obtained sensitivity of 100% and specificity of 72.6% to predict high‐risk varices, and, according to this cutoff, 133/175 of esophagogastroduodenoscopy could have been spared (76.0%), while according to Baveno guidelines, only 51/175 would have been spared (29.1%).ConclusionIn the era of noninvasive exams, spleen elastography with the 100‐Hz probe emerges as an excellent tool for prediction of presence of high‐risk varices. At the cutoff of 53.25 kPa, spleen elastography avoids upper endoscopy for screening for high‐risk varices, promising to be become part of the hepatologists' daily routine.

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“…In the study by Zhang et al, 7 the Baveno VII guideline proposed that for patients who do not meet the Baveno VI criteria, spleen stiffness measurement (SSM) ≤ 40 kPa could avoid further unnecessary endoscopic screening. Among patients whose SSM was assessed using a 50-Hz probe, the Baveno VII algorithm avoided more esophagogastroduodenoscopies (56.7% vs. 39.1%) compared with the Baveno VI criteria, respectively.…”

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confidence: 99%

Ten important original articles in the field of cirrhosis and portal hypertension from China

2023

Portal Hypertension & Cirrhosis

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Baveno VII algorithm outperformed other models in ruling out high-risk varices in individuals with HBV-related cirrhosis

Cited by 18 publications

References 29 publications

Risk and predictors of hepatic decompensation in grey zone patients by the Baveno VII criteria: A competing risk analysis

Risk and predictors of hepatic decompensation in grey zone patients by the Baveno VII criteria: A competing risk analysis

Spleen stiffness: a new tool to predict high‐risk varices in cirrhotic patients

Ten important original articles in the field of cirrhosis and portal hypertension from China

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