Baveno VII algorithm outperformed other models in ruling out high-risk varices in individuals with HBV-related cirrhosis

Abstract

The Baveno VII consensus recommends that spleen stiffness measurement (SSM) ≤40kPa 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. Consecutive individuals with HBV-related cirrhosis who underwent liver stiffness measurement (LSM) and SSM - using a 50Hz shear wave frequency, spleen diameter measurement, and esophagogastroduodenoscopy (EGD) were prospectively enrolled from June 2020. A 100Hz probe has been adopted for additional SSM assessment since July2021. 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 50Hz 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@100Hz was assessed in 232 patients, and the Baveno VII algorithm with SSM@100Hz spared more EGDs (75.4% vs. 59.5%, p<0.001) than that with SSM@50Hz, both with a missed HRV rate of 3.0% (1/33). We validated the Baveno VII algorithm, demonstrating the excellent performance of SSM@50Hz and SSM@100Hz in ruling out HRV in individuals with HBV-related cirrhosis. Furthermore, the Baveno VII algorithm with SSM@100Hz could safely rule out more EGDs than that with SSM@50Hz. NCT04890730. The Baveno VII guideline proposed that for patients who do not meet the Baveno VI criteria, SSM ≤40kPa could avoid further unnecessary endoscopic screening. The current study validated the Baveno VII algorithm using 50Hz and 100Hz probes, which both exhibited excellent performance in ruling out HRVs in individuals with HBV-related cirrhosis. Compared with the Baveno VII algorithm with SSM@50Hz, SSM@100Hz 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.