Evaluation of three “beyond Baveno VI” criteria to safely spare endoscopies in compensated advanced chronic liver disease

Giulia Tosetti, Massimo Primignani, Vincenzo La Mura, Roberta D'Ambrosio, Elisabetta Degasperi, Nicolò Mezzina, Mauro Viganò, Mariagrazia Rumi, Anna Ludovica Fracanzani, Rosa Lombardi, Silvia Fargion, Mirella Fraquelli, Alessio Aghemo, Pietro Lampertico

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3 Citations (Scopus)

Abstract

Background: Liver stiffness measurement (LSM) <20 kPa and platelet count >150,000/mm 3 exclude varices needing treatment (VNT) in viral compensated advanced chronic liver disease (cACLD), saving-up to 20–25% endoscopies (Baveno VI criteria). Refinements of such criteria to further reduce endoscopies and an approach without LSM (Platelet 150/MELD 6) were later proposed. Aims: To assess LSM 25/platelet 125, LSM 25/platelet 110 (Expanded-Baveno VI) and Platelet 150/MELD 6 accuracy versus Baveno VI criteria, and the impact of platelet count variability on criteria accuracy in all-etiologies cACLD. Methods: cACLD patients undergoing screening endoscopy with laboratory data within 6 months and LSM within one year. Results: Of 442 patients, 31% had varices (7% with VNT). Baveno VI criteria had 100% sensitivity (Se) and negative predictive value (NPV) and spared 19.5% endoscopies. “LSM 25/platelet 125” and “Expanded-Baveno VI” criteria maintained such accuracy, sparing 15% and 24% more endoscopies, respectively (p < 0.001). Platelet 150/MELD 6 was less accurate, misclassifying 10% VNT. Platelet count variability exceeded 8% and one VNT patient was misclassified with both “Expanded-Baveno VI” and “LSM 25/platelet 125” criteria considering the previous platelet count. Conclusions: Both “Expanded-Baveno VI” and “LSM 25/platelet 125” criteria are accurate in cACLD, but the former are more advantageous. Platelet 150/MELD 6 proved inadequate.

Original languageEnglish
Pages (from-to)1135-1140
JournalDigestive and Liver Disease
Volume51
Issue number8
DOIs
Publication statusPublished - 2019

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Endoscopy
Liver Diseases
Chronic Disease
Blood Platelets
Varicose Veins
Liver
Platelet Count
Therapeutics

Keywords

  • Compensated advance chronic liver disease
  • Variceal screening
  • Varices needing treatment

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

@article{a0e8a0e8d6f24549a20693cfff2839e9,
title = "Evaluation of three “beyond Baveno VI” criteria to safely spare endoscopies in compensated advanced chronic liver disease",
abstract = "Background: Liver stiffness measurement (LSM) <20 kPa and platelet count >150,000/mm 3 exclude varices needing treatment (VNT) in viral compensated advanced chronic liver disease (cACLD), saving-up to 20–25{\%} endoscopies (Baveno VI criteria). Refinements of such criteria to further reduce endoscopies and an approach without LSM (Platelet 150/MELD 6) were later proposed. Aims: To assess LSM 25/platelet 125, LSM 25/platelet 110 (Expanded-Baveno VI) and Platelet 150/MELD 6 accuracy versus Baveno VI criteria, and the impact of platelet count variability on criteria accuracy in all-etiologies cACLD. Methods: cACLD patients undergoing screening endoscopy with laboratory data within 6 months and LSM within one year. Results: Of 442 patients, 31{\%} had varices (7{\%} with VNT). Baveno VI criteria had 100{\%} sensitivity (Se) and negative predictive value (NPV) and spared 19.5{\%} endoscopies. “LSM 25/platelet 125” and “Expanded-Baveno VI” criteria maintained such accuracy, sparing 15{\%} and 24{\%} more endoscopies, respectively (p < 0.001). Platelet 150/MELD 6 was less accurate, misclassifying 10{\%} VNT. Platelet count variability exceeded 8{\%} and one VNT patient was misclassified with both “Expanded-Baveno VI” and “LSM 25/platelet 125” criteria considering the previous platelet count. Conclusions: Both “Expanded-Baveno VI” and “LSM 25/platelet 125” criteria are accurate in cACLD, but the former are more advantageous. Platelet 150/MELD 6 proved inadequate.",
keywords = "Compensated advance chronic liver disease, Variceal screening, Varices needing treatment",
author = "Giulia Tosetti and Massimo Primignani and {La Mura}, Vincenzo and Roberta D'Ambrosio and Elisabetta Degasperi and Nicol{\`o} Mezzina and Mauro Vigan{\`o} and Mariagrazia Rumi and Fracanzani, {Anna Ludovica} and Rosa Lombardi and Silvia Fargion and Mirella Fraquelli and Alessio Aghemo and Pietro Lampertico",
year = "2019",
doi = "10.1016/j.dld.2018.12.025",
language = "English",
volume = "51",
pages = "1135--1140",
journal = "Digestive and Liver Disease",
issn = "1590-8658",
publisher = "Elsevier B.V.",
number = "8",

}

TY - JOUR

T1 - Evaluation of three “beyond Baveno VI” criteria to safely spare endoscopies in compensated advanced chronic liver disease

AU - Tosetti, Giulia

AU - Primignani, Massimo

AU - La Mura, Vincenzo

AU - D'Ambrosio, Roberta

AU - Degasperi, Elisabetta

AU - Mezzina, Nicolò

AU - Viganò, Mauro

AU - Rumi, Mariagrazia

AU - Fracanzani, Anna Ludovica

AU - Lombardi, Rosa

AU - Fargion, Silvia

AU - Fraquelli, Mirella

AU - Aghemo, Alessio

AU - Lampertico, Pietro

PY - 2019

Y1 - 2019

N2 - Background: Liver stiffness measurement (LSM) <20 kPa and platelet count >150,000/mm 3 exclude varices needing treatment (VNT) in viral compensated advanced chronic liver disease (cACLD), saving-up to 20–25% endoscopies (Baveno VI criteria). Refinements of such criteria to further reduce endoscopies and an approach without LSM (Platelet 150/MELD 6) were later proposed. Aims: To assess LSM 25/platelet 125, LSM 25/platelet 110 (Expanded-Baveno VI) and Platelet 150/MELD 6 accuracy versus Baveno VI criteria, and the impact of platelet count variability on criteria accuracy in all-etiologies cACLD. Methods: cACLD patients undergoing screening endoscopy with laboratory data within 6 months and LSM within one year. Results: Of 442 patients, 31% had varices (7% with VNT). Baveno VI criteria had 100% sensitivity (Se) and negative predictive value (NPV) and spared 19.5% endoscopies. “LSM 25/platelet 125” and “Expanded-Baveno VI” criteria maintained such accuracy, sparing 15% and 24% more endoscopies, respectively (p < 0.001). Platelet 150/MELD 6 was less accurate, misclassifying 10% VNT. Platelet count variability exceeded 8% and one VNT patient was misclassified with both “Expanded-Baveno VI” and “LSM 25/platelet 125” criteria considering the previous platelet count. Conclusions: Both “Expanded-Baveno VI” and “LSM 25/platelet 125” criteria are accurate in cACLD, but the former are more advantageous. Platelet 150/MELD 6 proved inadequate.

AB - Background: Liver stiffness measurement (LSM) <20 kPa and platelet count >150,000/mm 3 exclude varices needing treatment (VNT) in viral compensated advanced chronic liver disease (cACLD), saving-up to 20–25% endoscopies (Baveno VI criteria). Refinements of such criteria to further reduce endoscopies and an approach without LSM (Platelet 150/MELD 6) were later proposed. Aims: To assess LSM 25/platelet 125, LSM 25/platelet 110 (Expanded-Baveno VI) and Platelet 150/MELD 6 accuracy versus Baveno VI criteria, and the impact of platelet count variability on criteria accuracy in all-etiologies cACLD. Methods: cACLD patients undergoing screening endoscopy with laboratory data within 6 months and LSM within one year. Results: Of 442 patients, 31% had varices (7% with VNT). Baveno VI criteria had 100% sensitivity (Se) and negative predictive value (NPV) and spared 19.5% endoscopies. “LSM 25/platelet 125” and “Expanded-Baveno VI” criteria maintained such accuracy, sparing 15% and 24% more endoscopies, respectively (p < 0.001). Platelet 150/MELD 6 was less accurate, misclassifying 10% VNT. Platelet count variability exceeded 8% and one VNT patient was misclassified with both “Expanded-Baveno VI” and “LSM 25/platelet 125” criteria considering the previous platelet count. Conclusions: Both “Expanded-Baveno VI” and “LSM 25/platelet 125” criteria are accurate in cACLD, but the former are more advantageous. Platelet 150/MELD 6 proved inadequate.

KW - Compensated advance chronic liver disease

KW - Variceal screening

KW - Varices needing treatment

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U2 - 10.1016/j.dld.2018.12.025

DO - 10.1016/j.dld.2018.12.025

M3 - Article

AN - SCOPUS:85060457487

VL - 51

SP - 1135

EP - 1140

JO - Digestive and Liver Disease

JF - Digestive and Liver Disease

SN - 1590-8658

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