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

Augustin, S; Pons, M; Maurice, JB; Bureau, C; Stefanescu, H; Ney, M; Blasco, H; ... Genescà, J; + view all (2017) Expanding the Baveno VI criteria for the screening of varices in patients with compensated advanced chronic liver disease. Hepatology , 66 (6) pp. 1980-1988. 10.1002/hep.29363. Green open access

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Abstract

Patients with compensated advanced chronic liver disease (cACLD) can safely avoid screening endoscopy with a platelet count >150x10(9) 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 x10(9) 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.

Type: Article
Title: Expanding the Baveno VI criteria for the screening of varices in patients with compensated advanced chronic liver disease
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1002/hep.29363
Publisher version: http://dx.doi.org/10.1002/hep.29363
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Transient elastography; Platelet counts; Portal hypertension; Compensated liver cirrhosis
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Inst for Liver and Digestive Hlth
URI: https://discovery.ucl.ac.uk/id/eprint/1563700
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