Background: Liver stiffness measurement (LSM) <20 kPa and platelet count >150,000/mm 3 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. Aims: 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. Methods: cACLD patients undergoing screening endoscopy with laboratory data within 6 months and LSM within one year. Results: 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. Conclusions: 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.

Evaluation of three “beyond Baveno VI” criteria to safely spare endoscopies in compensated advanced chronic liver disease / G. Tosetti, M. Primignani, V. La Mura, R. D'Ambrosio, E. Degasperi, N. Mezzina, M. Viganò, M. Rumi, A.L. Fracanzani, R. Lombardi, S. Fargion, M. Fraquelli, A. Aghemo, P. Lampertico. - In: DIGESTIVE AND LIVER DISEASE. - ISSN 1590-8658. - (2019 Jan 11). [Epub ahead of print] [10.1016/j.dld.2018.12.025]

Evaluation of three “beyond Baveno VI” criteria to safely spare endoscopies in compensated advanced chronic liver disease

G. Tosetti
Primo
;
V. La Mura;R. D'Ambrosio;E. Degasperi;N. Mezzina;M. Viganò;M. Rumi;A.L. Fracanzani;R. Lombardi;S. Fargion;A. Aghemo;P. Lampertico
2019

Abstract

Background: Liver stiffness measurement (LSM) <20 kPa and platelet count >150,000/mm 3 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. Aims: 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. Methods: cACLD patients undergoing screening endoscopy with laboratory data within 6 months and LSM within one year. Results: 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. Conclusions: 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.
Compensated advance chronic liver disease; Variceal screening; Varices needing treatment; Hepatology; Gastroenterology
Settore MED/12 - Gastroenterologia
11-gen-2019
Article (author)
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/641048
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