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Volume 39 Issue 4
Apr.  2023
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Article Navigation >  Journal of Clinical Hepatology  > 2023  >  39(4): 818-825

Value of different Baveno Ⅶ-based criteria in screening for high-risk esophageal and gastric varices in advanced chronic liver disease

DOI: 10.3969/j.issn.1001-5256.2023.04.012
  • 1.

    Department of Gastroenterology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China

  • 2.

    Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China

Research funding:

National Natural Science Foundation of China Youth Fund (81900505);

The Science and Technology Development Project of China State Railway Group (J2021Z609)

More Information
  • Corresponding author: WU Jing, wujing36youyi@ccmu.edu.cn (ORCID: 0000-0002-8255-1953)
  • Received Date: 2022-09-13
  • Accepted Date: 2022-11-09
  • Published Date: 2023-04-20
    Abstract
  •   Objective  To investigate the value of Baveno Ⅶ criteria versus Expanded Baveno Ⅶ criteria in screening for high-risk varices (HRV) in patients with compensated advanced chronic liver disease (cACLD).  Methods  A total of 146 patients with cACLD who were admitted to Beijing Shijitan Hospital, Capital Medical University, from January 2016 to December 2018 were enrolled, and according to the absence or presence of HRV based on gastroscopy, they were divided into HRV group with 68 patients and control group with 78 patients. Clinical data, liver stiffness measurement (LSM), and gastroscopy findings were analyzed, and different Baveno Ⅶ criteria were analyzed in terms of their sensitivity and specificity in the diagnosis of HRV. The Mann-Whitney U test and the McNemar test were used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. A univariate logistic regression analysis was performed for the variables used to predict HRV, and a multivariate analysis was performed for the variables with P < 0.1. The two sets of Baveno Ⅶ criteria were compared in terms of their sensitivity and specificity in the diagnosis of HRV.  Results  A total of 146 patients were enrolled in the study, among whom 68 (46.6%) were found to have HRV. The median age was 54 years (range 29-84 years), male patients accounted for 65.8%, and hepatitis B virus was the main etiology observed in 115 patients (78.8%). The univariate logistic regression analysis showed that LSM and platelet count (PLT) were associated with HRV (both P < 0.05). The multivariate analysis showed that based on Baveno Ⅶ criteria, LSM > 20 kPa or PLT < 150×109/L was associated with HRV (both P < 0.05), and based on Expanded Baveno Ⅶ criteria, LSM > 25 kPa or PLT < 110×109/L was associated with HRV (both P < 0.05). LSM and PLT had an area under the ROC curve of 0.797 (95% confidence interval [CI]: 0.723-0.859) and 0.789 (95% CI: 0.714-0.852), respectively, in the diagnosis of HRV. There were significant differences in the prevalence rates of esophageal and gastric varices and HRV between the patients who met Baveno Ⅶ criteria and those who did not meet such criteria (χ2=23.14 and 23.14, both P < 0.001), as well as between the patients who met Expanded Baveno Ⅶ criteria and those who did not meet such criteria (χ2=43.51 and 25.71, both P < 0.001). Although a higher proportion of patients were exempted from gastroscopy based on Expanded Baveno Ⅶ criteria (32.9% vs 13.7%), Baveno Ⅶ criteria had higher sensitivity (0.98 vs 0.88) and negative predictive value (0.95 vs 0.83) and could better avoid the missed diagnosis of HRV (1.0% vs 9.3%).  Conclusion  Baveno Ⅶ criteria are more suitable for the screening for HRV in cACLD patients in China.

     

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