Evaluation of Baveno VII Criteria in Ruling out High Risk Varices in Cirrhotic Egyptian Patients

Abstract

Background: Most serious complications of liver cirrhosis, including ascites, esophageal varices (EV), and variceal hemorrhage, are  brought on by portal hypertension. It has been suggested that screening with a gastroscopy be used to evaluate EV and bleeding risk in  patients with cirrhosis. Gastroscopy, however, is a costly and intrusive surgery that carries some risk. Esophageal varices and high-risk  varices have been identified or ruled out using noninvasive screening techniques such as liver and spleen stiffness.

Objective: Our goal was to confirm that, in Egyptian cirrhotic individuals, spleen stiffness, liver stiffness, and platelet count (PLT) can be used to rule out high-risk varices.

Subjects and Methods: A total of 155 individuals with liver cirrhosis were included in cross-sectional study based on whether they had  esophageal varices or not using esophagogastroduodenoscopy. The patients were sorted into three distinct groups according to the  degree of varices: Those without varices, those with low-risk varices, and those with high-risk varices.

Results: It was observed that the high-risk varices group had greater liver and spleen stiffness measurements than the no varices and  low risk varices groups. Spleen stiffness at a cut-off level of < 45 kpa is optimum in ruling out high risk varices (HRV) with 93.85%  sensitivity, 96.67% specificity 95.3% PPV and 95.6% NPV with P value <0.001 and AUC of 0.981, while liver stiffness for ruling out HRV, the  optimum cut-off level was < 29.1 kpa with 71.11% sensitivity, 95.38% specificity, 95.52% PPV and 70.45% NPV with P value <0.001 and AUC  of 0.886. Platelets at a cut-off level <93 can rule out HRV with 84.44% sensitivity, 96.92% specificity, 97.44% PPV and 81.82% NPV with P  value <0.001 and AUC=0.898.

Conclusions: In Egyptian cirrhotic individuals, spleen stiffness in addition to liver stiffness and PLT may be  helpful in ruling out high-risk varices, which is consistent with the Baveno VII criteria.