Clin Mol Hepatol > Accepted Articles
Baveno-VII criteria to predict decompensation and initiate non-selective beta-blocker in compensated advanced chronic liver disease patients
Yu Jun Wong1,2 , Chen Zhaojin3, Guilia Tosetti4, Elisabetta Degasperi4, Sanchit Sharma5, Samagra Agarwal5, Liu Chuan6, Chan Yiong Huak3, Li Jia7, Qi Xiaolong6, Anoop Saraya5, Massimo Primignani4
1Department of Gastroenterology & Hepatology, Changi General Hospital, Singapore
2Duke-NUS Academic Clinical Program, SingHealth, Singapore
3Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
4Division of Gastroenterology and Hepatology, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
5Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Science, India
6CHESS Center, Institute of Portal Hypertension, the First Hospital of Lanzhou University, Lanzhou, China
7Department of Gastroenterology & Hepatology, Tianjin Second People’s Hospital, Tianjin, China
Correspondence :  Yu Jun Wong ,
Received: June 23, 2022  Revised: August 24, 2022   Accepted: August 29, 2022
The utility of Baveno-VII criteria of clinically significant portal hypertension (CSPH) to predict decompensation and the need for non-selective beta-blockers (NSBB) in compensated advanced chronic liver disease (cACLD) patient needs validation. We aim to validate the performance of CSPH criteria to predict the risk of decompensation in an international real-world cohort of cACLD patients.
In this retrospective analysis of an international registry, cACLD patients were stratified into 3 categories (CSPH excluded, grey zone & CSPH). The risks of decompensation across different CSPH categories were estimated using competing risk regression for clustered data, with death and HCC as competing events. The performance of “treating definite CSPH” strategy to prevent decompensation using NSBB was compared against other strategies using decision curve analysis.
1,159 cACLD patients (36.8% had CSPH) were included; 7.2% experienced decompensation over a median follow-up of 40 (30-52) months. Non-invasive assessment of CSPH predicts a 5-fold higher risk of liver decompensation in cACLD patients [sHR 5.5 (95%CI: 4.0-7.4)]. “Probable CSPH” is suboptimal to predict decompensation risk in cACLD patients. CSPH exclusion criteria reliably exclude cACLD patients at risk of decompensation, regardless of etiology. Among cACLD patients in the grey zone, the decompensation risk was negligible among viral-related cACLD, but was substantially higher among the non-viral cACLD group. Decision curve analysis showed that “treating definite CSPH” strategy is superior to “treating all varices” or “treating probable CSPH” strategy to prevent decompensation using NSBB.
Non-invasive assessment of CSPH may stratify decompensation risk and the need for NSBB in cACLD patients.
KeyWords: Portal Hypertension; Clinically significant portal hypertension; Non-invasive; Liver Cirrhosis; Elastography

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