TOPLINE:

In a large US health system cohort, the Baveno VI criteria — which rely on simple, noninvasive tests — showed high sensitivity for ruling out clinically significant portal hypertension (CSPH) and high-risk varices in patients with cirrhosis, thereby allowing many to safely avoid routine screening endoscopies.

METHODOLOGY:

• The Baveno VI criteria combine a quick liver stiffness scan (FibroScan) and a platelet count (platelet count > 150 × 10⁹/L and liver stiffness measurement < 20 kPa) to identify patients with cirrhosis who are unlikely to have CSPH or high-risk varices; prior validations were mostly outside the US.
• Researchers performed a retrospective analysis of 428 patients with cirrhosis (mean age, 62.53 years; 49.1% female; liver stiffness measurement ≥ 10 kPa) in a large integrated US health system to evaluate the performance characteristics of the Baveno VI criteria in identifying CSPH.
• Included patients underwent FibroScan and esophagogastroduodenoscopy plus a complete blood count within 12 months of the FibroScan; at least 6 months of follow-up after the FibroScan date was mandatory.
• Varices were classified by standard endoscopic criteria as small, medium, and large.
• Primary outcomes were sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the Baveno VI criteria for ruling out CSPH based on endoscopic and radiologic evidence.

TAKEAWAY:

• The Baveno VI criteria had a sensitivity of 84.8% (95% CI, 80.1-88.8), a specificity of 32.4% (95% CI, 24.9-40.7), a PPV of 71% (95% CI, 68.4-73.5), and an NPV of 52.2% (95% CI, 43.2-61.1) for ruling out CSPH.
• However, nearly half (47.8%) of patients classified as “ruled out” by the Baveno VI criteria still had endoscopic or imaging evidence of CSPH, mostly small varices, portal hypertensive gastropathy, or imaging collaterals.
• When used to rule out medium-to-large varices that require treatment, the Baveno VI criteria showed a sensitivity of 95.1% (95% CI, 83.5-99.4) and an NPV of 97.9% (95% CI, 91.8-99.4).
• Applying the criteria would have avoided 90 (21.0%) of screening endoscopies in the study cohort.

IN PRACTICE:

“Our findings confirm that the Baveno VI criteria have high sensitivity for ruling out clinically significant portal hypertension and high-risk varices, offering a reliable method to identify low-risk patients who can safely avoid unnecessary endoscopies,” the authors of the study concluded.

SOURCE:

The study was led by Marcia A.Y. Leung, MD, Kaiser Permanente-Northern California. It was published online in Gastro Hep Advances.

LIMITATIONS:

The study was limited by its retrospective design. It relied on endoscopic and imaging findings rather than hepatic venous pressure gradient measurements to confirm the noninvasive diagnosis of CSPH. Additionally, the study population was drawn from an integrated Northern California health system, possibly limiting the generalizability of the findings to nonintegrated or fee-for-service systems.

DISCLOSURES:

The study was supported by grants from the Kaiser Permanente Northern California Graduate Medical Education Biostatistical Consulting Unit and the National Cancer Institute. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.