Expanding the Baveno VI criteria for the screening of varices in patients with compensated advanced chronic liver disease

ABSTRACT

Patients with compensated advanced chronic liver disease (cACLD) can safely avoid screening endoscopy with a platelet count >150x10⁹ cells/L and liver stiffness measurement (LSM) <20 kPa (Baveno VI criteria). However, the total number of avoided endoscopies using this rule is relatively low. We aimed at expanding the Baveno VI criteria and validating them in additional cohorts. Patients from the Anticipate cohort (499 patients with cACLD of different etiologies) were used to study the performance of different thresholds of platelets and LSM for the identification of patients at very low risk (<5%) of having varices needing treatment (VNT). The new criteria (Expanded-Baveno VI) were validated in two additional cohorts from London (309 patients) and Barcelona (117 patients). The performance of the new criteria by etiology of cACLD was also assessed. The best new expanded classification rule was platelet count >110 x10⁹ cells/L and LSM <25 kPa. This was validated in the two additional cohorts. Overall, the Expanded-Baveno VI criteria would potentially spare 367 (40%) of endoscopies (21% with Baveno-VI criteria) with a risk of missing VNT of 1.6% (95% CI: 0.7-3.5%) in patients within the criteria and 0.6% (95% CI: 0.3-1.4%) in the overall population of 925 patients evaluated. The Expanded-Baveno VI criteria performed well in cACLD patients with hepatitis C virus, alcoholic and nonalcoholic steatohepatitis. Conclusion: The new Expanded-Baveno VI criteria spare more endoscopies than the original criteria with a minimal risk of missing VNT in most of the main etiologies of cACLD. This article is protected by copyright. All rights reserved.

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