Baveno VII Criteria Is an Accurate Risk Stratification Tool to Predict High-Risk Varices Requiring Intervention and Hepatic Events in Patients with Advanced Hepatocellular Carcinoma

Abstract

The Baveno VII criteria are used in patients with liver cirrhosis to predict high-risk varices in patients with liver cirrhosis. Yet its use in patients with advanced hepatocellular carcinoma (HCC) has not been validated. HCC alone is accompanied with a higher variceal bleeding risk due to its association with liver cirrhosis and portal vein thrombosis. The use of systemic therapy in advanced HCC has been thought to further augment this risk. Upper endoscopy is commonly used to evaluate for the presence of varices before initiation of treatment with systemic therapy. Yet it is associated with procedural risks, waiting time and limited availability in some localities which may delay the commencement of systemic therapy. Our study successfully validated the Baveno VI criteria with a 3.5% varices needing treatment (VNT) missed rate, also with acceptable <5% VNT missed rates when considering alternative liver stiffness (LSM) and platelet cut-offs. The Baveno VII clinically significant portal hypertension rule-out criteria (LSM < 15 kPa and platelet >150 × 109/L) also revealed a low frequency (2%) of hepatic events, whilst the rule-in criteria (LSM > 25 kPa) was predictive of a higher proportion of hepatic events (14%). Therefore, our study has successfully validated the Baveno VII criteria as a non-invasive stratification of the risk of variceal bleeding and hepatic decompensation in the HCC population.

Evaluation of Baveno VII Criteria in Ruling out High Risk Varices in Cirrhotic Egyptian Patients

“…The updated Baveno VII consensus extends its scope to encompass the diagnosis of compensated advanced chronic liver disease (cACLD) and clinically significant portal hypertension (CSPH). This expanded application enables the anticipation of the risk associated with developing decompensated liver disease and variceal hemorrhage (7) . The Baveno VII criteria advocates for patients with a liver stiffness measurement (LSM) of ≤15 kPa and a platelet count (PLT) exceeding 150 × 10^9/L, suggesting a >90% likelihood of excluding clinically significant portal hypertension (CSPH).…”