Abstract
Background
Combination of liver stiffness measurement and platelets count is a tool to safely
rule out varices needing treatment (VNT) in patients with compensated advanced chronic
liver disease (cACLD). Aims: to evaluate 4-year liver-related complications and survival
in low-risk patients according to Baveno VI criteria.
Methods
we conducted a monocentric retrospective analysis of prospectively collected data
of all consecutive patients, with cirrhosis (LSM≥12.5 kPa) and without previous complication,
evaluated between 2012 and 2015. Liver-related complications and survival were compared
between 2 groups of patients: favourable (LSM< 20 kPa and platelet count>150.000/mm3)
and unfavourable Baveno VI status patients (LSM ≥ 20 kPa or platelet count ≤150.000/mm3).
Results
455 patients with cACLD were analysed. Two hundred patients had favourable Baveno
VI criteria, 3.6% with VNT. The 4-year probability of being free of acute decompensation
was higher in low-risk patients (94.4 ± 1.8% vs. 85.7%±2.6%, p = 0.018). Unfavourable Baveno status was independently associated with acute decompensation.
The probability of being free of HCC was significantly higher in low-risk patients
(94.2 ± 1.8% vs. 87.6 ± 2.4%, p = 0.048). Liver-related mortality was not different between the 2 groups (p = 0.56).
Conclusion
The Baveno VI criteria could predict clinical outcome in cACLD.
Keywords
Abbreviations:
PHT (Portal hypertension), HE (Hepatic Encephalopathy), VB (Variceal Bleeding), VNT (Varices Needing Treatment), cACLD (compensated Advanced Chronic Liver Disease), LSM (Liver Stiffness Measurement), HVPG (Hepatic Venous Pressure Gradient), HCC (Hepatocellular Carcinoma), TE (Transient elastography), AST (Aspartate aminotransferase), ALT (Alanine aminotransferase), CHC (Chronic Hepatitis C), CHB (Chronic Hepatitis B), NASH (Non Alcoholic Steatohepatitis), SVR (sustained viral response), INR (International Normalized Ratio), BMI (Body Mass Index), MELD (Model for End-Stage Liver Disease), CI (Confidence Interval), PSVD (Porto-Sinusoidal Vascular Disease), cccDNA (covalently closed circular DNA), MAFLD (Metabolic Associated Fatty Liver Disease)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Digestive and Liver DiseaseAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension.J Hepatol. 2010; 53: 762-768https://doi.org/10.1016/j.jhep.2010.06.004
- Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies.J Hepatol. 2006; 44: 217-231https://doi.org/10.1016/j.jhep.2005.10.013
- Preventing the development of varices in cirrhosis.J Clin Gastroenterol. 2007; 41 Suppl 3: S300-S304https://doi.org/10.1097/MCG.0b013e318157c63d
- Prognostic indicators of survival in patients with compensated and decompensated cirrhosis.Liver Int. 2012; 32: 1407-1414https://doi.org/10.1111/j.1478-3231.2012.02830.x
- Competing risks and prognostic stages of cirrhosis: a 25-year inception cohort study of 494 patients.Aliment Pharmacol Ther. 2014; 39: 1180-1193https://doi.org/10.1111/apt.12721
- Updating consensus in portal hypertension: report of the Baveno III Consensus Workshop on definitions, methodology and therapeutic strategies in portal hypertension.J Hepatol. 2000; 33: 846-852https://doi.org/10.1016/s0168-8278(00)80320-7
- Endoscopic screening for varices in cirrhotic patients: data from a national endoscopic database.Gastrointest Endosc. 2007; 65: 82-88https://doi.org/10.1016/j.gie.2006.08.023
- Advances and challenges in cirrhosis and portal hypertension.BMC Med. 2017; 15: 200https://doi.org/10.1186/s12916-017-0966-6
- Non-invasive diagnosis of large oesophageal varices with FibroTest in patients with cirrhosis: a preliminary retrospective study.Liver Int. 2006; 26: 271-278https://doi.org/10.1111/j.1478-3231.2005.01227.x
- Transient elastography accurately predicts presence of significant portal hypertension in patients with chronic liver disease.Aliment Pharmacol Ther. 2008; 27: 1261-1268https://doi.org/10.1111/j.1365-2036.2008.03701.x
- Now there are many (stages) where before there was one: in search of a pathophysiological classification of cirrhosis.Hepatology. 2010; 51: 1445-1449https://doi.org/10.1002/hep.23478
- Elastography, spleen size, and platelet count identify portal hypertension in patients with compensated cirrhosis.Gastroenterology. 2013; 144 (e1): 102-111https://doi.org/10.1053/j.gastro.2012.10.001
- Blood tests to diagnose fibrosis or cirrhosis in patients with chronic hepatitis C virus infection.Ann Intern Med. 2013; 159: 370-371https://doi.org/10.7326/0003-4819-159-5-201309030-00019
- Noninvasive tools and risk of clinically significant portal hypertension and varices in compensated cirrhosis: the “Anticipate” study.Hepatology. 2016; 64: 2173-2184https://doi.org/10.1002/hep.28824
- Ruling out esophageal varices in NAFLD cirrhosis: can we do without endoscopy?.J. Hepatol. 2018; 69: 769-771https://doi.org/10.1016/j.jhep.2018.06.013
- Expanding consensus in portal hypertension: report of the Baveno VI Consensus Workshop: stratifying risk and individualizing care for portal hypertension.J Hepatol. 2015; 63: 743-752https://doi.org/10.1016/j.jhep.2015.05.022
- Validation of the Baveno VI criteria to identify low risk cirrhotic patients not requiring endoscopic surveillance for varices.J Hepatol. 2016; 65: 899-905https://doi.org/10.1016/j.jhep.2016.06.021
- Validating, deconstructing and refining Baveno criteria for ruling out high-risk varices in patients with compensated cirrhosis.Liver Int. 2017; 37: 1177-1183https://doi.org/10.1111/liv.13379
- Validation of noninvasive methods to predict the presence of gastroesophageal varices in a cohort of patients with compensated advanced chronic liver disease: validation of noninvasive methods.J Gastroenterol Hepatol. 2017; 32: 1867-1872https://doi.org/10.1111/jgh.13781
- Validation of the Baveno VI and the expanded Baveno VI criteria to identify patients who could avoid screening endoscopy.Liver Int. 2018; 38: 1442-1448https://doi.org/10.1111/liv.13732
- Non-invasive prediction of esophageal varices by stiffness and platelet in non-alcoholic fatty liver disease cirrhosis.J Hepatol. 2018; 69: 878-885https://doi.org/10.1016/j.jhep.2018.05.019
- Validation of Baveno VI criteria for screening and surveillance of esophageal varices in patients with compensated cirrhosis and a sustained response to antiviral therapy.Gastroenterology. 2019; 156 (e5): 997-1009https://doi.org/10.1053/j.gastro.2018.11.053
- Performance of Baveno VI and expanded Baveno VI criteria for excluding high-risk varices in patients with chronic liver diseases: a systematic review and meta-analysis.Clin Gastroenterol Hepatol. 2019; 17 (e11): 1744-1755https://doi.org/10.1016/j.cgh.2019.04.062
- Expanding the Baveno VI criteria for the screening of varices in patients with compensated advanced chronic liver disease.Hepatology. 2017; 66: 1980-1988https://doi.org/10.1002/hep.29363
- Validation of original, expanded Baveno VI, and stepwise & platelet-MELD criteria to rule out varices needing treatment in compensated cirrhosis from various etiologies.Ann Hepatol. 2019; https://doi.org/10.1016/j.aohep.2019.08.005
- Baveno VI and Expanded Baveno VI criteria succesfully predicts the absence of high-risk gastro-oesophageal varices in a Chilean cohort.Liver Int. 2020; https://doi.org/10.1111/liv.14373
- A randomized trial to assess whether portal pressure guided therapy to prevent variceal rebleeding improves survival in cirrhosis.Hepatology. 2017; 65: 1693-1707https://doi.org/10.1002/hep.29056
- Emerging non-invasive approaches for diagnosis and monitoring of portal hypertension.Lancet Gastroenterol Hepatol. 2018; 3: 708-719https://doi.org/10.1016/S2468-1253(18)30232-2
- 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.Circulation. 2014; 129: S49-S73https://doi.org/10.1161/01.cir.0000437741.48606.98
- Baseline and serial liver stiffness measurement in prediction of portal hypertension progression for patients with compensated cirrhosis.Liver Int. 2014; 34: 1340-1348https://doi.org/10.1111/liv.12525
- Two-dimensional shear wave elastography predicts survival in advanced chronic liver disease.Gut. 2021; https://doi.org/10.1136/gutjnl-2020-323419
- β blockers to prevent decompensation of cirrhosis in patients with clinically significant portal hypertension (PREDESCI): a randomised, double-blind, placebo-controlled, multicentre trial.Lancet. 2019; 393: 1597-1608https://doi.org/10.1016/S0140-6736(18)31875-0
- Hepatic venous pressure gradient predicts development of hepatocellular carcinoma independently of severity of cirrhosis.J Hepatol. 2009; 50: 923-928https://doi.org/10.1016/j.jhep.2009.01.014
- Molecular biology of hepatitis B virus infection.Virology. 2015; 479–480: 672-686https://doi.org/10.1016/j.virol.2015.02.031
- Total area of spontaneous portosystemic shunts independently predicts hepatic encephalopathy and mortality in liver cirrhosis.J Hepatol. 2020; 72: 1140-1150https://doi.org/10.1016/j.jhep.2019.12.021
- Differential inflammasome activation predisposes to acute-on-chronic liver failure in human and experimental cirrhosis with and without previous decompensation.Gut. 2021; 70: 379-387https://doi.org/10.1136/gutjnl-2019-320170
- Liver stiffness by transient elastography to detect porto-sinusoidal vascular liver disease with portal hypertension.Hepatology. 2020; https://doi.org/10.1002/hep.31688
- Non-invasive prediction of high-risk varices in patients with primary biliary cholangitis and primary sclerosing cholangitis.Am J Gastroenterol. 2019; 114: 446-452https://doi.org/10.1038/s41395-018-0265-7
Article info
Publication history
Published online: September 25, 2021
Accepted:
September 6,
2021
Received:
May 13,
2021
Identification
Copyright
© 2021 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.