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

Research output: Contribution to journalArticle

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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Keywords

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

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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