Validation and Refinement of the Baveno VI Criteria for Ruling Out High-Risk Varices

Zhou, Hong; Hu, Han Hwa; Tian, Maoyong; Chu, Jun; Tian, Caiyun; Yang, Yanqing; Lin, Shen

doi:10.1155/2020/4217512

Cited by 4 publications

(3 citation statements)

References 73 publications

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“…Patients with liver cirrhosis are at high risk for developing EVB, a condition that is linked to a high death rate. Thus, HRV screening is required for cirrhotic patients receiving treatment (11) . According to Garcia-Tsao et al (12) , a gastroscopy should be part of the screening process for EV and bleeding risk assessment.…”

Section: Discussionmentioning

confidence: 99%

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

2024

The Egyptian Journal of Hospital Medicine

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Background: Most serious complications of liver cirrhosis, including ascites, esophageal varices (EV), and variceal hemorrhage, are brought on by portal hypertension. It has been suggested that screening with a gastroscopy be used to evaluate EV and bleeding risk in patients with cirrhosis. Gastroscopy, however, is a costly and intrusive surgery that carries some risk. Esophageal varices and high-risk varices have been identified or ruled out using noninvasive screening techniques such as liver and spleen stiffness. Objective: Our goal was to confirm that, in Egyptian cirrhotic individuals, spleen stiffness, liver stiffness, and platelet count (PLT) can be used to rule out high-risk varices. Subjects and Methods: A total of 155 individuals with liver cirrhosis were included in cross-sectional study based on whether they had esophageal varices or not using esophagogastroduodenoscopy. The patients were sorted into three distinct groups according to the degree of varices: Those without varices, those with low-risk varices, and those with high-risk varices. Results: It was observed that the high-risk varices group had greater liver and spleen stiffness measurements than the no varices and low risk varices groups. Spleen stiffness at a cut-off level of < 45 kpa is optimum in ruling out high risk varices (HRV) with 93.85% sensitivity, 96.67% specificity 95.3% PPV and 95.6% NPV with P value <0.001 and AUC of 0.981, while liver stiffness for ruling out HRV, the optimum cut-off level was < 29.1 kpa with 71.11% sensitivity, 95.38% specificity, 95.52% PPV and 70.45% NPV with P value <0.001 and AUC of 0.886. Platelets at a cut-off level <93 can rule out HRV with 84.44% sensitivity, 96.92% specificity, 97.44% PPV and 81.82% NPV with P value <0.001 and AUC=0.898. Conclusions: In Egyptian cirrhotic individuals, spleen stiffness in addition to liver stiffness and PLT may be helpful in ruling out high-risk varices, which is consistent with the Baveno VII criteria.

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Section: Discussionmentioning

confidence: 99%

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

2024

The Egyptian Journal of Hospital Medicine

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“…These clinical characteristics may infer better applicability of our findings to the Asia-Pacific region than in the West. Nevertheless, Baveno VII criteria have been shown to maintain a high reliability in ruling out VNT in different ethnicities or aetiologies including virus-, alcohol-and non-obese NASH-related cACLD [27]. The use of the ANTICIPATE-NASH model (with LSM, PLT and BMI) in overcoming the low positive predictive value in obese NASH-related cACLD still requires further evaluation [28].…”

Section: Predictors Of Vnt and Hepatic Eventsmentioning

confidence: 99%

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

Lui

Wong

et al. 2023

Cancers

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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.

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“…The Baveno VI consensus recommended that endoscopy can be avoided safely in patients with cACLD or compensated liver cirrhosis with a liver stiffness measurement (LSM) <20 kPa and platelet count (PLT) >150 ×10 9 /L ( de Franchis, 2015 ). These criteria have been validated extensively and found to have high reliability and safety for excluding patients without HRVs; a very low (<5%) risk of missing HRVs has been documented ( Zhou et al, 2020 ). In 2017, the American Association for the Study of Liver Disease recommended using Baveno VI criteria to stratify the EV risk in patients with liver cirrhosis ( Garcia-Tsao et al, 2017 ).…”

Section: Introductionmentioning

confidence: 99%

VariScreen secures the screening of high-risk varices in patients with hepatitis B virus-related cirrhosis beyond Baveno VI criteria

et al. 2022

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We aimed to validate the performance of the ratio of the platelet count (PLT) to liver stiffness measurement (LSM) in excluding high-risk varices (HRVs) in patients with hepatitis B virus (HBV)-related compensated cirrhosis beyond Baveno VI criteria. A total of 310 patients were assessed. The performances of the PLT:LSM ratio (PLER), PLER adjusted for the international normalized ratio, etiology, age, and sex (PLEASE), and the sequential algorithm for HRV screening (VariScreen) in excluding HRVs were evaluated and compared with those of expanded Baveno VI criteria (LSM <25 kPa and PLT >110×109/L, EB6C); PLT >150×109/L and model for end-stage liver disease score = 6 (P150M6 criterion); PLT >120×109/L and albumin >36 g/L (P120A36 criterion); and albumin-bilirubin (ALBI) grade and PLT score (ALBI-PLT score). Among the enrolled patients, 43 (13.9%) had HRVs. The area under the receiver operating characteristic curve of PLER for predicting HRVs (0.771, 95% confidence interval, 0.720–0.817) was significantly higher than that for PLT and LSM (p < 0.01). PLER was an independent risk factor for HRVs. VariScreen, PLEASE, and PLER could spare 20 (6.5%), 91 (29.4%), and 60 (19.4%) endoscopies, with 0, 3 (3.3%), and 1 (1.7%) HRVs missed, respectively. The EB6C and P120A36 criteria could spare 45 (14.5%) and 36 (11.6%) endoscopies, with 1 (2.2%) and 1 (2.8%) HRVs missed, respectively. The P150M6 criterion and ALBI-PLT score missed 6.8% and 10.3% of HRVs, respectively. We found that PLER performed better than other non-invasive tests. VariScreen secured the screening of HRVs in patients with HBV-related cirrhosis beyond Baveno VI criteria.

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Validation and Refinement of the Baveno VI Criteria for Ruling Out High-Risk Varices

Cited by 4 publications

References 73 publications

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

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

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

VariScreen secures the screening of high-risk varices in patients with hepatitis B virus-related cirrhosis beyond Baveno VI criteria

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