Baveno VII algorithm outperformed other models in ruling out high-risk varices in individuals with HBV-related cirrhosis
Open accessAbstract
BACKGROUND & AIMS: The Baveno VII consensus recommends that spleen stiffness measurement (SSM) ≤40 kPa is safe for ruling out high-risk varices (HRVs) and avoiding endoscopic screening in patients who do not meet the Baveno VI criteria. This study aimed to validate the performance of the Baveno VII algorithm in individuals with HBV-related cirrhosis. METHODS: Consecutive individuals with HBV-related cirrhosis who underwent liver stiffness measurement (LSM) and SSM - using a 50 Hz shear wave frequency, spleen diameter measurement, and esophagogastroduodenoscopy (EGD) were prospectively enrolled from June 2020. A 100 Hz probe has been adopted for additional SSM assessment since July 2021. RESULTS: From June 2020 to January 2022, 996 patients were screened and 504 were enrolled for analysis. Among the 504 patients in whom SSM was assessed using a 50 Hz probe, the Baveno VII algorithm avoided more EGDs (56.7% vs. 39.1%, p <0.001) than Baveno VI criteria, with a comparable missed HRV rate (3.8% vs. 2.5%). Missed HRV rates were >5% for all other measures: 11.3% for LSM-longitudinal spleen diameter to platelet ratio score, 20.0% for platelet count/longitudinal spleen diameter ratio, and 8.8% for Rete Sicilia Selezione Terapia-hepatitis. SSM@100 Hz was assessed in 232 patients, and the Baveno VII algorithm with SSM@100 Hz spared more EGDs (75.4% vs. 59.5%, p <0.001) than that with SSM@50 Hz, both with a missed HRV rate of 3.0% (1/33). CONCLUSIONS: We validated the Baveno VII algorithm, demonstrating the excellent performance of SSM@50 Hz and SSM@100 Hz in ruling out HRV in individuals with HBV-related cirrhosis. Furthermore, the Baveno VII algorithm with SSM@100 Hz could safely rule out more EGDs than that with SSM@50 Hz. CLINICAL TRIAL NUMBER: NCT04890730. IMPACT AND IMPLICATIONS: The Baveno VII guideline proposed that for patients who do not meet the Baveno VI criteria, SSM ≤40 kPa could avoid further unnecessary endoscopic screening. The current study validated the Baveno VII algorithm using 50 Hz and 100 Hz probes, which both exhibited excellent performance in ruling out HRVs in individuals with HBV-related cirrhosis. Compared with the Baveno VII algorithm with SSM@50 Hz, SSM@100 Hz had a better capability to safely rule out unnecessary EGDs. Baveno VII algorithm will be a practical tool to triage individuals with cirrhosis in future clinical practice.
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The current dedicated probe for spleen stiffness measurement uses ultrasound at a frequency of 100 Hz.
“The current dedicated probe for spleen stiffness measurement uses ultrasound at a frequency of 100 Hz. 481”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [481]
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- Authors
- Zhang, X., Song, J., Zhang, Y., Wen, B., Dai, L., Xi, R., Wu, Q., Li, Y., Luo, X., Lan, X., He, Q., Luo, W., Lai, Q., Ji, Y., Zhou, L., Qi, T., Liu, M., Zhou, F., Wen, W., Li, H., Liu, Z., Chen, Y., Zhu, Y., Li, J., Huang, J., Cheng, X., Tu, M., Hou, J., Wang, H., & Chen, J.
- Affiliations
- Nanfang Hospital (CN)
- Chengdu Medical College (CN)
- Corresponding author
- Wang, Haiyu
- Chen, Jinjun
- ORCID
- Venue
- Journal of Hepatology
- Publisher
- Elsevier BV
- Published
- 2023-03
- Volume
- 78
- Issue
- 3
- Pages
- 574-583
- ISSN
- 0168-8278 (ISSN-L)
- OpenAlex
- W4308462830
- Cited by
- 62
- References
- 29
- Citations by year
- 2026: 19 · 2025: 25 · 2024: 12 · 2023: 6
- FWCI
- 6.39
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Hepatology (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Funders
- Southern Medical University (2020CR026)
- Department of Education of Guangdong Province (2019Z003, LC2019ZD006)
- National Key Research and Development Program of China (2017YFC0908100)
- National Major Science and Technology Projects of China (2018ZX10302206, 2018ZX10723203)
- Special Project for Research and Development in Key areas of Guangdong Province (2019B020227004)
- National Natural Science Foundation of China (82070650)
- Guangdong Provincial Pearl River Talents Program (2017BT01S131)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal Bleeding Diagnosis and Treatment
- Keywords
- high-risk varices, hepatitis B cirrhosis, spleen stiffness measurement, liver stiffness measurement, shear wave elastography, Baveno VI criteria, esophagogastric varices, spleen diameter, platelet count, algorithm validation
- MeSH terms
- Algorithms, Esophageal and Gastric Varices, Hepatitis B virus, Humans, Liver Cirrhosis, Varicose Veins, Elasticity Imaging Techniques
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