Baveno criteria safely identify patients with compensated advanced chronic liver disease who can avoid variceal screening endoscopy: A diagnostic test accuracy meta-analysis

Zsolt Szakács, Bálint Erőss, Alexandra Soós, Péter Mátrai, Imre Szabó, Erika Pétervári, Judit Bajor, Nelli Farkas, P. Hegyi, Anita Illés, Margit Solymár, M. Balaskó, Patrícia Sarlós, Ákos Szűcs, József Czimmer, A. Vincze, G. Pár

Research output: Contribution to journalArticle

Abstract

Background: The Baveno VI Consensus Workshop defined criteria (liver stiffness measured by transient elastography <20 kPa and platelet count >150 × 109 cells/L) to identify those patients with compensated advanced chronic liver diseases (cACLD) who are unlikely to have varices needing treatment (VNTs) and can safely avoid variceal screening endoscopy. This meta-analysis aimed to quantify the safety and efficacy of these criteria in suspected cACLD with liver stiffness >10 kPa and in compensated chronic liver diseases (cCLD) irrespective of liver stiffness. Methods: A systematic search was conducted in nine databases for studies discussed cACLD or cCLD and tested Baveno criteria against variceal screening endoscopy. The main safety and efficacy endpoints were missed VNT rate and spared endoscopy rate (SER), respectively; calculated with the random effect model. Pooled sensitivity, specificity, and area under the curve (AUC) were calculated with the hierarchical summary receiver operating characteristic model. For all outcome measures, 95% confidence intervals were computed. Heterogeneity was tested with I2-statistics. Results: The search yielded 13 studies including 4,464 patients which reported on suspected cACLD. Pooled missed VNT rate was 0.3% (0.1–0.6%; I2 = 45.5%), pooled SER was 32.8% (24.8–41.4%; I2 = 97.0%). Sensitivity, specificity, and AUC of Baveno criteria were 97% (95–98%), 41% (27–57%), and 96% (94–97%), respectively. In the subgroups of cACLD from hepatitis C and B viruses, non-alcoholic fatty liver disease/steatohepatitis, or alcohol, missed VNT rates were 0.0% (0.0–0.3%), 1.2% (0.4–2.2%), 0.0% (0.0–1.3%), or 0.0% (0.0–0.4%), while SERs were 24.2% (20.5–28.1%), 24.9% (21.7–28.4%), 38.6% (10.9–70.8%), or 27.0% (16.9–38.4%), respectively. If we expanded the study population to cCLD, 27 studies included 7,534 patients. Missed VNT rate was 0.2% (0.1–0.5%; I2 = 39.8%) with a SER of 30.5% (25.2– 36.2%; I2 = 96.1%) while Se, Sp, and AUC were 97% (93–99%), 35% (27–44%), and 80% (77–84%), respectively. Conclusions: The application of Baveno criteria significantly reduces the number of unnecessary variceal screening endoscopies while being safe: cACLD patients with liver stiffness <20 kPa and platelet count > 150 × 109 cells/L carry a very low chance (i.e., 0.3%) of having VNTs. The criteria preserve low missed VNT rate with lower diagnostic performance among cCLD patients.

Original languageEnglish
Article number1028
JournalFrontiers in Physiology
Volume10
Issue numberAUG
DOIs
Publication statusPublished - Jan 1 2019

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Routine Diagnostic Tests
Endoscopy
Meta-Analysis
Liver Diseases
Chronic Disease
Varicose Veins
Area Under Curve
Liver
Therapeutics
Consensus Development Conferences
Elasticity Imaging Techniques
Safety
Sensitivity and Specificity
Fatty Liver
Hepatitis B virus
ROC Curve
Hepacivirus
Alcohols
Outcome Assessment (Health Care)
Databases

Keywords

  • Diagnostic accuracy
  • Fibroscan
  • High-risk varices
  • Platelets
  • Variceal bleeding prediction

ASJC Scopus subject areas

  • Physiology
  • Physiology (medical)

Cite this

Baveno criteria safely identify patients with compensated advanced chronic liver disease who can avoid variceal screening endoscopy : A diagnostic test accuracy meta-analysis. / Szakács, Zsolt; Erőss, Bálint; Soós, Alexandra; Mátrai, Péter; Szabó, Imre; Pétervári, Erika; Bajor, Judit; Farkas, Nelli; Hegyi, P.; Illés, Anita; Solymár, Margit; Balaskó, M.; Sarlós, Patrícia; Szűcs, Ákos; Czimmer, József; Vincze, A.; Pár, G.

In: Frontiers in Physiology, Vol. 10, No. AUG, 1028, 01.01.2019.

Research output: Contribution to journalArticle

Szakács, Z, Erőss, B, Soós, A, Mátrai, P, Szabó, I, Pétervári, E, Bajor, J, Farkas, N, Hegyi, P, Illés, A, Solymár, M, Balaskó, M, Sarlós, P, Szűcs, Á, Czimmer, J, Vincze, A & Pár, G 2019, 'Baveno criteria safely identify patients with compensated advanced chronic liver disease who can avoid variceal screening endoscopy: A diagnostic test accuracy meta-analysis', Frontiers in Physiology, vol. 10, no. AUG, 1028. https://doi.org/10.3389/fphys.2019.01028
Szakács, Zsolt ; Erőss, Bálint ; Soós, Alexandra ; Mátrai, Péter ; Szabó, Imre ; Pétervári, Erika ; Bajor, Judit ; Farkas, Nelli ; Hegyi, P. ; Illés, Anita ; Solymár, Margit ; Balaskó, M. ; Sarlós, Patrícia ; Szűcs, Ákos ; Czimmer, József ; Vincze, A. ; Pár, G. / Baveno criteria safely identify patients with compensated advanced chronic liver disease who can avoid variceal screening endoscopy : A diagnostic test accuracy meta-analysis. In: Frontiers in Physiology. 2019 ; Vol. 10, No. AUG.
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title = "Baveno criteria safely identify patients with compensated advanced chronic liver disease who can avoid variceal screening endoscopy: A diagnostic test accuracy meta-analysis",
abstract = "Background: The Baveno VI Consensus Workshop defined criteria (liver stiffness measured by transient elastography <20 kPa and platelet count >150 × 109 cells/L) to identify those patients with compensated advanced chronic liver diseases (cACLD) who are unlikely to have varices needing treatment (VNTs) and can safely avoid variceal screening endoscopy. This meta-analysis aimed to quantify the safety and efficacy of these criteria in suspected cACLD with liver stiffness >10 kPa and in compensated chronic liver diseases (cCLD) irrespective of liver stiffness. Methods: A systematic search was conducted in nine databases for studies discussed cACLD or cCLD and tested Baveno criteria against variceal screening endoscopy. The main safety and efficacy endpoints were missed VNT rate and spared endoscopy rate (SER), respectively; calculated with the random effect model. Pooled sensitivity, specificity, and area under the curve (AUC) were calculated with the hierarchical summary receiver operating characteristic model. For all outcome measures, 95{\%} confidence intervals were computed. Heterogeneity was tested with I2-statistics. Results: The search yielded 13 studies including 4,464 patients which reported on suspected cACLD. Pooled missed VNT rate was 0.3{\%} (0.1–0.6{\%}; I2 = 45.5{\%}), pooled SER was 32.8{\%} (24.8–41.4{\%}; I2 = 97.0{\%}). Sensitivity, specificity, and AUC of Baveno criteria were 97{\%} (95–98{\%}), 41{\%} (27–57{\%}), and 96{\%} (94–97{\%}), respectively. In the subgroups of cACLD from hepatitis C and B viruses, non-alcoholic fatty liver disease/steatohepatitis, or alcohol, missed VNT rates were 0.0{\%} (0.0–0.3{\%}), 1.2{\%} (0.4–2.2{\%}), 0.0{\%} (0.0–1.3{\%}), or 0.0{\%} (0.0–0.4{\%}), while SERs were 24.2{\%} (20.5–28.1{\%}), 24.9{\%} (21.7–28.4{\%}), 38.6{\%} (10.9–70.8{\%}), or 27.0{\%} (16.9–38.4{\%}), respectively. If we expanded the study population to cCLD, 27 studies included 7,534 patients. Missed VNT rate was 0.2{\%} (0.1–0.5{\%}; I2 = 39.8{\%}) with a SER of 30.5{\%} (25.2– 36.2{\%}; I2 = 96.1{\%}) while Se, Sp, and AUC were 97{\%} (93–99{\%}), 35{\%} (27–44{\%}), and 80{\%} (77–84{\%}), respectively. Conclusions: The application of Baveno criteria significantly reduces the number of unnecessary variceal screening endoscopies while being safe: cACLD patients with liver stiffness <20 kPa and platelet count > 150 × 109 cells/L carry a very low chance (i.e., 0.3{\%}) of having VNTs. The criteria preserve low missed VNT rate with lower diagnostic performance among cCLD patients.",
keywords = "Diagnostic accuracy, Fibroscan, High-risk varices, Platelets, Variceal bleeding prediction",
author = "Zsolt Szak{\'a}cs and B{\'a}lint Erőss and Alexandra So{\'o}s and P{\'e}ter M{\'a}trai and Imre Szab{\'o} and Erika P{\'e}terv{\'a}ri and Judit Bajor and Nelli Farkas and P. Hegyi and Anita Ill{\'e}s and Margit Solym{\'a}r and M. Balask{\'o} and Patr{\'i}cia Sarl{\'o}s and {\'A}kos Szűcs and J{\'o}zsef Czimmer and A. Vincze and G. P{\'a}r",
year = "2019",
month = "1",
day = "1",
doi = "10.3389/fphys.2019.01028",
language = "English",
volume = "10",
journal = "Frontiers in Physiology",
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TY - JOUR

T1 - Baveno criteria safely identify patients with compensated advanced chronic liver disease who can avoid variceal screening endoscopy

T2 - A diagnostic test accuracy meta-analysis

AU - Szakács, Zsolt

AU - Erőss, Bálint

AU - Soós, Alexandra

AU - Mátrai, Péter

AU - Szabó, Imre

AU - Pétervári, Erika

AU - Bajor, Judit

AU - Farkas, Nelli

AU - Hegyi, P.

AU - Illés, Anita

AU - Solymár, Margit

AU - Balaskó, M.

AU - Sarlós, Patrícia

AU - Szűcs, Ákos

AU - Czimmer, József

AU - Vincze, A.

AU - Pár, G.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: The Baveno VI Consensus Workshop defined criteria (liver stiffness measured by transient elastography <20 kPa and platelet count >150 × 109 cells/L) to identify those patients with compensated advanced chronic liver diseases (cACLD) who are unlikely to have varices needing treatment (VNTs) and can safely avoid variceal screening endoscopy. This meta-analysis aimed to quantify the safety and efficacy of these criteria in suspected cACLD with liver stiffness >10 kPa and in compensated chronic liver diseases (cCLD) irrespective of liver stiffness. Methods: A systematic search was conducted in nine databases for studies discussed cACLD or cCLD and tested Baveno criteria against variceal screening endoscopy. The main safety and efficacy endpoints were missed VNT rate and spared endoscopy rate (SER), respectively; calculated with the random effect model. Pooled sensitivity, specificity, and area under the curve (AUC) were calculated with the hierarchical summary receiver operating characteristic model. For all outcome measures, 95% confidence intervals were computed. Heterogeneity was tested with I2-statistics. Results: The search yielded 13 studies including 4,464 patients which reported on suspected cACLD. Pooled missed VNT rate was 0.3% (0.1–0.6%; I2 = 45.5%), pooled SER was 32.8% (24.8–41.4%; I2 = 97.0%). Sensitivity, specificity, and AUC of Baveno criteria were 97% (95–98%), 41% (27–57%), and 96% (94–97%), respectively. In the subgroups of cACLD from hepatitis C and B viruses, non-alcoholic fatty liver disease/steatohepatitis, or alcohol, missed VNT rates were 0.0% (0.0–0.3%), 1.2% (0.4–2.2%), 0.0% (0.0–1.3%), or 0.0% (0.0–0.4%), while SERs were 24.2% (20.5–28.1%), 24.9% (21.7–28.4%), 38.6% (10.9–70.8%), or 27.0% (16.9–38.4%), respectively. If we expanded the study population to cCLD, 27 studies included 7,534 patients. Missed VNT rate was 0.2% (0.1–0.5%; I2 = 39.8%) with a SER of 30.5% (25.2– 36.2%; I2 = 96.1%) while Se, Sp, and AUC were 97% (93–99%), 35% (27–44%), and 80% (77–84%), respectively. Conclusions: The application of Baveno criteria significantly reduces the number of unnecessary variceal screening endoscopies while being safe: cACLD patients with liver stiffness <20 kPa and platelet count > 150 × 109 cells/L carry a very low chance (i.e., 0.3%) of having VNTs. The criteria preserve low missed VNT rate with lower diagnostic performance among cCLD patients.

AB - Background: The Baveno VI Consensus Workshop defined criteria (liver stiffness measured by transient elastography <20 kPa and platelet count >150 × 109 cells/L) to identify those patients with compensated advanced chronic liver diseases (cACLD) who are unlikely to have varices needing treatment (VNTs) and can safely avoid variceal screening endoscopy. This meta-analysis aimed to quantify the safety and efficacy of these criteria in suspected cACLD with liver stiffness >10 kPa and in compensated chronic liver diseases (cCLD) irrespective of liver stiffness. Methods: A systematic search was conducted in nine databases for studies discussed cACLD or cCLD and tested Baveno criteria against variceal screening endoscopy. The main safety and efficacy endpoints were missed VNT rate and spared endoscopy rate (SER), respectively; calculated with the random effect model. Pooled sensitivity, specificity, and area under the curve (AUC) were calculated with the hierarchical summary receiver operating characteristic model. For all outcome measures, 95% confidence intervals were computed. Heterogeneity was tested with I2-statistics. Results: The search yielded 13 studies including 4,464 patients which reported on suspected cACLD. Pooled missed VNT rate was 0.3% (0.1–0.6%; I2 = 45.5%), pooled SER was 32.8% (24.8–41.4%; I2 = 97.0%). Sensitivity, specificity, and AUC of Baveno criteria were 97% (95–98%), 41% (27–57%), and 96% (94–97%), respectively. In the subgroups of cACLD from hepatitis C and B viruses, non-alcoholic fatty liver disease/steatohepatitis, or alcohol, missed VNT rates were 0.0% (0.0–0.3%), 1.2% (0.4–2.2%), 0.0% (0.0–1.3%), or 0.0% (0.0–0.4%), while SERs were 24.2% (20.5–28.1%), 24.9% (21.7–28.4%), 38.6% (10.9–70.8%), or 27.0% (16.9–38.4%), respectively. If we expanded the study population to cCLD, 27 studies included 7,534 patients. Missed VNT rate was 0.2% (0.1–0.5%; I2 = 39.8%) with a SER of 30.5% (25.2– 36.2%; I2 = 96.1%) while Se, Sp, and AUC were 97% (93–99%), 35% (27–44%), and 80% (77–84%), respectively. Conclusions: The application of Baveno criteria significantly reduces the number of unnecessary variceal screening endoscopies while being safe: cACLD patients with liver stiffness <20 kPa and platelet count > 150 × 109 cells/L carry a very low chance (i.e., 0.3%) of having VNTs. The criteria preserve low missed VNT rate with lower diagnostic performance among cCLD patients.

KW - Diagnostic accuracy

KW - Fibroscan

KW - High-risk varices

KW - Platelets

KW - Variceal bleeding prediction

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