Expanding the Baveno VI criteria for the screening of varices in patients with compensated advanced chronic liver disease

Abstract

The new Expanded-Baveno VI criteria spare more endoscopies than the original criteria with a minimal risk of missing VNT in most of the main etiologies of cACLD. (Hepatology 2017;66:1980-1988).

Validation of the Baveno VI and the expanded Baveno VI criteria to identify patients who could avoid screening endoscopy

“…Baveno VI criteria, which are based on LSM and platelet count, could identify patients who are at minimum risk of HRVs. Baveno VI criteria were developed and validated in Western studies, where the aetiology of liver disease was mostly HCV . Our cohort comprised Asians with HBV as the main aetiology that was underrepresented in prior studies.…”

“…For patients with multiple platelet count measurements, we used the count nearest the TE. We used LSM and platelet count to ascertain whether individual patients fulfilled the Baveno VI (LSM < 20 kPa with platelet count >150 000 cells/μL) or the extended Baveno VI (LSM < 25 kPa with platelet count >110 000 cells/μL) criteria …”

“…We classified the aetiologies as HBV, HCV, alcoholic liver disease and non‐alcoholic fatty liver disease, based on serum hepatitis B surface antigen, hepatitis C antibody, radiological imaging studies assessing steatosis and clinical history. The cACLD was defined by LSM ≥ 10 kPa, Child‐Pugh class A and absence of prior decompensation …”

“…These criteria were validated in 310 patients, mostly with hepatitis C virus (HCV) (55%), and the Baveno VI criteria correctly identified 98% of patients who could safely avoid endoscopy . More recently, the Baveno VI criteria were validated in 925 patients, mostly with hepatitis C (62.8%), and the expanded Baveno VI criteria (LSM <25 kPa with platelet count >110 000 cells/μL) were proposed as better criteria than the original criteria . However, these criteria require cross‐validation, especially in Asian populations, where hepatitis B virus (HBV) is a major cause of cirrhosis.…”

Defining the Minimum Acceptable Diagnostic Accuracy of Noninvasive Fibrosis Testing in Cirrhosis: A Decision Analytic Modeling Study

“…The mortality from cirrhosis was reduced by 10% and by 50% over the 2‐year horizon to account for the impact of etiology‐specific treatment such as viral eradication in chronic hepatitis C, abstinence in alcohol‐related liver disease, or weight loss in nonalcoholic fatty liver disease. The prevalence of cirrhosis was modeled at 1% as population estimates of cirrhosis prevalence range from 0.1% to 2.1% The probability of varices when cirrhosis was present was reduced to 34.8% to reflect more contemporaneous estimates from observational studies The mortality from HCC in surveilled and unsurveilled patients was altered using data from a recent meta‐analysis of observational studies …”