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Extending and validating the Baveno VI criteria for the exclusion of high-risk varices

Andreea Barbulescu1, Iulia Ratiu2, Ioan Sporea3

  • 1Department of Gastroenterology and Hepatology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania. barbulescu.andra91@gmail.com.

Medical Ultrasonography
|March 3, 2021
PubMed

Insights

The Baveno VI guidelines accurately exclude high-risk varices (HRV) in cirrhotic patients. Adding albumin thresholds improves accuracy, potentially eliminating unnecessary esophago-gastro-duodenoscopy (EGD) screenings.

Area of Science:

  • Hepatology
  • Gastroenterology
  • Diagnostic Accuracy

Background:

  • Compensated advanced chronic liver disease (cACLD) management guidelines recommend screening for high-risk varices (HRV).
  • Esophago-gastro-duodenoscopy (EGD) is the standard for HRV screening but is invasive.
  • The Baveno VI guidelines suggest avoiding EGD in cACLD patients with liver stiffness (LSM) <20 kPa and platelet count (PLT) >150,000/L.

Purpose of the Study:

  • To validate the extended Baveno VI criteria in a large cohort of patients with chronic liver disease.
  • To establish specific cut-off values for liver stiffness and platelet count for HRV screening in the study population.
  • To assess the utility of albumin levels in refining HRV risk stratification.

Main Methods:

  • Retrospective analysis of 839 patients with liver cirrhosis.
  • Evaluation using Transient Elastography (TE), laboratory tests, and upper endoscopy within one year.
  • Validation of Baveno VI criteria on a randomly selected cohort (Cohort 1, n=728) and determination of tailored cut-offs, with validation on a separate cohort (Cohort 2, n=111).

Main Results:

  • Baveno VI criteria demonstrated 86.2% accuracy in Cohort 1.
  • Tailored cut-offs for ruling out HRV were PLT >150,000/mm³ and LSM <19.6 kPa.
  • Albumin <3.4 g/dL was independently associated with HRV in the grey-zone. The rule-out criteria achieved 100% accuracy in Cohort 2.

Conclusions:

  • The Baveno VI criteria show good accuracy for excluding HRV in cirrhotic patients.
  • Incorporating an albumin threshold enhances the performance and applicability of HRV screening criteria.
  • Utilizing the derived rule-out criteria can effectively prevent unnecessary EGD procedures.
Abstract

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