Liver stiffness measurement (LSM) <20 kPa and platelet count >150,000/mm3 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.
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.
cACLD patients undergoing screening endoscopy with laboratory data within 6 months and LSM within one year.
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.
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.
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Published online: January 10, 2019
Accepted: December 25, 2018
Received: August 31, 2018
© 2019 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
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- Beyond Baveno VI: How far are we?Digestive and Liver DiseaseVol. 51Issue 8
- PreviewVariceal bleeding is a major complication in patients with cirrhosis, with still a high mortality rate despite improvements in therapy and management. Gastroesophageal varices can develop when hepatic venous pressure gradient (HVPG) is ≥10 mmHg. The risk of variceal bleeding is directly related with variceal size. Patients with medium and large varices have the highest risk of bleeding. Also, the presence of small varices with red wale marks or the presence of any-size varices in patients with Child-Pugh class C have been associated with a high risk of bleeding.