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iNature
The Baveno VII consensus recommends that spleen hardness measurement (SSM) ≤ 40kpa is safe for patients who do not meet Baveno VI criteria and can be used to exclude high-risk varicose veins (HRV) and avoid endoscopic screening
.
This study aims to validate the performance
of the Baveno VII algorithm in patients with HBV-associated cirrhosis.
On November 7, 2022, Chen Jinjun and Wang Haiyu of Southern Medical University jointly published an online newsletter entitled " Baveno VII algorithm outperformed other models in ruling out high-risk varices in individuals with HBV-related cirrhosis", which conducted 996 patients screened and 504 were included in the analysis from June 2020 to January 2022
。 Among 504 patients using a 50Hz probe, the Baveno VII algorithm avoided more esophagogastroduodenoscopy (EDG) than the Baveno VI algorithm (56.
7% vs.
39.
1%, p<0.
001), and the HRV leakage rate (3.
8% vs.
2.
5%) was comparable
。 LSM-Longitudinal Spleen Diameter/Platelet Ratio Score (LSPS) was 11.
3%, Platelet Count/Longitudinal Spleen Diameter Ratio (PSR) was 20.
0%, Rete Sicilia Selezione Terapia-hepatitis (RESIST) was 8.
8%, and HRV Leakage Rate was >5%.
。 SSM@100 Hz was evaluated in 232 patients, and the Baveno VII algorithm SSM@100 Hz avoided more EDG (75.
4% vs.
59.
5%, p<0.
001) compared to SSM@ 50 Hz, both with an HRV leakage rate of 3.
0% (1/33)
.
In summary, the study verified that the Baveno VII algorithm at both SSM@50 Hz and SSM@100 Hz demonstrated excellent performance
in excluding HRV in patients with HBV-associated cirrhosis.
In addition, the SSM@100 Hz Baveno VII algorithm safely excludes more EDG
compared to SSM@50 Hz.
In addition, on October 26, 2022, Chen Jinjun of Southern Medical University and Rajiv Jalan collaborated to publish a report entitled "Prognostic and therapeutic significance of microbial cell-free DNA in plasma of people with" online in the Journal of Hepatology acutely decompensated cirrhosis", which uses metagenomic next-generation sequencing (mNGS) to evaluate genomic fragments of circulating microbes in patients with acute decompensation of liver cirrhosis, suggests that NHVs may have a pathogenic role
in the complication of AD.
Further validation is needed to determine whether this should be incorporated into the daily management of AD patients (click to read).
On October 8, 2020, Chen Jinjun and Hou Jinlin of Southern Medical University jointly published a joint newsletter entitled "Baveno VI criteria and spleen stiffness measurement rule out high-risk varices in virally suppressed" online in the Journal of Hepatology HBV-related cirrhosis", which validates the performance
of Baveno VI criteria combined with splenic hardness (SSM) (≤46 kPa) in excluding high-risk varicose veins that maintain viral suppression of HBV-associated cirrhosis 。 In excluding HRV in HBV-associated cirrhosis patients with suppressed virus, the combination of Baveno VI criteria plus SSM is safer to avoid more unnecessary endoscopy (61.
6%), resulting in more than half of oesophagogastroduodenoscopy being exempted
than using Baveno VI criteria or SSM alone.
This study prospectively validated the excellent performance
of the combination model in excluding high-risk esophageal varices in patients with HBV-associated cirrhosis who maintain viral suppression.
The performance of the combined model in excluding high-risk varicose veins was 95.
71% sensitivity, 76.
38% specificity, 98.
57% negative predictive value, and 0.
06 negative likelihood ratio
.
to screen and monitor patients with advanced chronic liver disease (ACLD) or cirrhosis of the esophageal varices (EV).
The Baveno VI consensus emphasizes that patients with compensatory ACLDs (cACLDs) with liver stiffness measurement (LSM) < 20 kPa and platelet counts > 150,000/μL are safe to avoid unnecessary EGD
.
The ability of the Baveno VI criteria to exclude HRV has been extensively validated in a variety of patient populations, including etiology and treatment status (hepatitis C and B).
Nevertheless, the Baveno VI standard avoids 15-40% of unwanted EGDs with mild to moderate specificity (26-46%)
.
Spleen hardness measurement (SSM) has proven to be a valuable tool
for assessing portal hypertension.
For untreated cACLD patients who do not meet Baveno VI criteria, SSMs ≤ 46 kPa are recommended to avoid more EGD screening, with a <5% missed rate for HRV, which has been validated
in patients with viral suppression.
Both studies used a shear wave frequency of 50 Hz for SSM assessment
.
In addition, a study using a 100 Hz probe showed that SSM@100 Hz achieved the best performance
in determining HRV at a cut-off of 41.
3 kPa 。 Therefore, for patients who do not meet the criteria of Baveno VI, the recent Baveno VII consensus suggests that SSM≤40kpa can avoid more unnecessary EGDs with HRV deletion rates <5%, which need to be validated
in different clinical scenarios.
In addition, several alternative non-invasive algorithms
have been studied for EGDs with a <5% HRV misclassification rate.
Among them, LSM-Longitudinal Spleen Diameter to Platelet Ratio Score (LSPS), Platelet Count/Longitudinal Spleen Diameter Ratio (PSR) and Rete Sicilia Selezione Terapia-hepatitis (RESIST) algorithms have been tested and validated
by some researchers.
Further studies are needed to compare the performance
of the above algorithms in excluding unnecessary EGDs.
The study aims to validate the performance of the Baveno VII algorithm in excluding HRV in patients with HBV-associated cirrhosis and to compare its performance
between SSM@50 Hz and SSM@100 Hz probes.
The Baveno VII algorithm was compared with other non-invasive models to study its safety and ability to
exclude unwanted EGDs.
The study ran from June 2020 to January 2022, with 996 patients screened and 504 included in the analysis
.
Among 504 patients using a 50Hz probe, the Baveno VII algorithm avoided more gastroscopy (EDG) than the Baveno VI algorithm (56.
7% vs.
39.
1%, p<0.
001), and HRV leakage rate (3.
8% vs.
2.
5%) was comparable
。 LSM-Longitudinal Spleen Diameter/Platelet Ratio Score (LSPS) was 11.
3%, Platelet Count/Longitudinal Spleen Diameter Ratio (PSR) was 20.
0%, Rete Sicilia Selezione Terapia-hepatitis (RESIST) was 8.
8%, and HRV Leakage Rate was >5%.
。 SSM@100 Hz was evaluated in 232 patients, and the Baveno VII algorithm SSM@100 Hz avoided more EDG (75.
4% vs.
59.
5%, p<0.
001) compared to SSM@ 50 Hz, both with an HRV leakage rate of 3.
0% (1/33).
In conclusion, the study verified that both the Baveno VII algorithm at SSM@50 Hz and SSM@100 Hz demonstrated excellent performance
in excluding HRV in patients with HBV-associated cirrhosis.
In addition, the SSM@100 Hz Baveno VII algorithm can safely exclude more EDG
compared to SSM@50 Hz.
Reference:
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The content is [iNature]
