Validation of the Baveno VI criteria to identify low risk cirrhotic patients not requiring endoscopic surveillance for varices

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• 作者：James B Maurice¹ ; ² ; Edgar Brodkin¹ ; Frances Arnold¹ ; Annalan Navaratnam¹ ; Heidi Paine² ; Sabrina Khawar¹ ; Ameet Dhar² ; David Patch¹ ; James O&rsquo ; Beirne¹ ; Raj Mookerjee¹ ; ³ ; Massimo Pinzani¹ ; ³ ; Emmanouil Tsochatzis¹ ; ³ ; Rachel H. Westbrook¹ ; ^{Rachel.westbrook@nhs.net" class="auth_mail" title="E-mail the corresponding author}
• 关键词：AUROC ; area under the receiver operator curve ; HVPG ; hepatic venous pressure gradient ; TE ; transient elastography ; LSM ; liver stiffness measurement ; kPa ; kilopascals ; OGD ; oesophagogastroduodenoscopy ; cACLD ; compensated advanced chronic liver disease ; LRV ; low risk varices ; HRV ; high risk varices ; INR ; international normalised ratio ; HCV ; hepatitis C ; ALD ; alcohol related liver disease ; NAFLD ; non-alcoholic fatty liver disease ; HBV ; hepatitis B ; PPV ; positive predictive value ; NPV ; negative pred
• 刊名：Journal of Hepatology
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：65
• 期：5
• 页码：899-905
• 全文大小：685 K

文摘

The Baveno VI guidelines propose that cirrhotic patients with a liver stiffness measurement (LSM) <20 kPa and a platelet count >150,000/μl can avoid screening endoscopy as their combination is highly specific for excluding clinically significant varices. The aim of the study was to validate these criteria.

Methods

Transient elastography data was collected from two institutions from 2006–2015. Inclusion criteria were a LSM ⩾10 kPa and an upper gastrointestinal endoscopy within 12 months, with a diagnosis of compensated chronic liver disease. Exclusion criteria were porto-mesenteric-splenic vein thrombosis and non-cirrhotic portal hypertension. Varices were graded as low risk (grade <2) or high risk (grade ⩾2).

Results

The study included 310 patients (169 (55%) hepatitis C, and 275 (89%) Child-Pugh A). Varices were present in 23% cases, with 5% prevalence of high risk varices. Overall 102/310 (33%) met the Baveno VI criteria. Within this group 11% had varices and 2% had high risk varices, representing 2/15 (13%) of all high risk varices. The Baveno VI criteria gave a sensitivity 0.87, specificity 0.34, positive predictive value 0.06, negative predictive value 0.98, positive likelihood ratio 1.31 and negative likelihood ratio 0.39. The AUROC for LSM and platelet count combined was 0.746.

Conclusions

The Baveno VI criteria performed well correctly identifying 98% of patients who could safely avoid endoscopy.

Lay summary

This study examines the effectives of a recent set of guidelines published by the Baveno VI conference, which states that patients with chronic liver disease and a low liver stiffness (<20 kPa) and high platelet count (>150) are at low risk of having varices and do not need a screening endoscopy. Varices are a complication of cirrhosis, confer a risk of serious bleeding, and can be diagnosed and treated by endoscopy. Our study reviewed the clinical records of patients who have had liver stiffness scans and endoscopy over a 9-year period at two hospitals. The results show that only about 2% of patients who meet the Baveno VI criteria will be miss-classified as not having varices.