Validation of Revised Baveno VI Criteria for Screening of Varices Needing Treatment in Children with Cirrhosis

Abstract

Background

Baveno VI criteria for screening varices needing treatment (VNT) have not yet been validated in an exclusive pediatric and adolescent set of the population, in whom baseline parameters differ in relation to adults. Therefore, our primary objective was to validate Baveno VI and its expanded form in children below 18 years of age. The secondary aim was to elicit whether any revision of the above criteria with a target of not missing more than 5% VNT could be more accurate for this age group.

Materials and Methods

The work was carried out in two medical institutes, over a span of 3 years. Consecutively enrolled patients below 18 years of age, with compensated cirrhosis confirmed by liver biopsy, were evaluated for related blood parameters, transient elastography (TE) and esophagogastroduodenoscopy.

Results

Out of the 33 recruited patients, five (15.15%) met the criteria for VNT. The sensitivity, specificity, PPV and NPV of Baveno VI and Expanded Baveno VI were observed as 60%, 92.3%, 60% and 92.3%, and 20%, 100%, 100% and 88%, respectively. We found that the Revised Baveno VI criteria with TE <19 kPa and platelet count of >175×10⁹ cells/L, with sensitivity 100%, specificity 79%, PPV 45%, NPV 100% and accuracy of 82%, are more appropriate for this age group.

Conclusion

We propose that further multicentrer studies with a larger sample size should be conducted before incorporating Revised Baveno VI criteria for high-risk varices in patients below 18 years in future guidelines.

Keywords:

• transient elastography
• platelet count
• compensated advanced chronic liver disease
• cACLD
• high-risk varices

Author Details

Authors were formerly attached as Assistant Professor: Sutapa Ganguly, and Professor: Sutapa Ganguly, in the Department of Pediatrics, Nil Ratan Sircar Medical College, Kolkata, India.

Acknowledgment

The authors acknowledge the assistance of Dr Anup Sarkar, Senior Resident, Department of Medical Gastroenterology, Medical College, Kolkata-73, India, for his contribution to the performance of procedures.

Author Contributions

This is to state that all authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed on the journal to which the article will be submitted; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest for this work. This study received no special or exclusive financial support.

Additional information

Funding

The investigations were carried out in house using the existing resources of the institutions, which are funded by the Department of Health and Family Welfare, Government of West Bengal, India.