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

Figures & data

Table 1 Descriptive Statistics of Baseline Characteristics of VNT, non-VNT and Total Cases

Parameters	VNT (n=5)	Non-VNT (n=28)	Total (n=33)
Age (mean±SD) (years)	13.4±2.1	10.83±1.03	11.26±0.93
Sex (M:F)	1.5:1	1.33:1	1.35:1
PELD score (mean±SD) (n=17)	11.3 (n=1)	10.38±6.52 (n=16)	10.44±0.6.33
MELD-Na score (mean±SD) (n=16)	18±3.6 (n=4)	11.47±2.74 (n=12)	13.06±4.02
Growth failure (n)	1	16	17
TE (mean±SD) (kPa)	21.5±1.11	16.5±0.54	17.26±0.58
+SD of TE (mean±SD)	15.8±1.24	10.7±0.66	11.48±0.67
PC (mean±SD) (×10^9 cells/L)	108±17	211±16	195±15
TSB (mean±SD) (mg/dL)	6.1±2.18	4±0.7	4.38±0.67
S Alb (mean±SD) (g/dL)	3.5±0.18	3.36±0.05	3.38±0.05
AST (mean±SD) (IU/L)	193±26.7	168.5±14.8	172.2±13.1
INR (mean±SD)	1.46±0.02	1.26±0.03	1.28±0.03

Abbreviations: VNT, varices needing treatment; SD, standard deviation; PELD, Pediatric End Stage Liver Disease; MELD-Na, Model for End Stage Liver Disease–Sodium; TE, transient elastography; PC, platelet count; TSB, total serum bilirubin; S Alb, serum albumin; AST, serum aspartate aminotransferase; INR, international normalized ratio.

Table 2 Values of the Statistical Parameters of the Selected Continuous Variables in Relation to Presence of VNT

Statistical Parameters	TE	+SD of TE	PC	TSB	S Alb	AST	INR
rb	0.83	0.79	−0.65	0.26	0.23	0.17	0.26
p	0.01	0.01	0.04	0.32	0.38	0.5	0.29
AUROC	0.91	0.89	0.9	0.71	0.62	0.60	0.76

Abbreviations: VNT, varices needing treatment; r_b, biserial correlation coefficient; p, p values of logistic regression in respect to variables; AUROC, area under the receiver operator characteristics curve; TE, transient elastography; SD, standard deviation; PC, platelet count; TSB, total serum bilirubin; S Alb, serum albumin; AST, serum aspartate aminotransferase; INR, international normalized ratio.

Figure 1 ROC curves of the dependent potential continuous variables in reference to non-invasive screening of varices needing treatment (VNT).

Abbreviations: TE, transient elastography; SD, standard deviation; INR, international normalized ratio; AST, aspartate amino transferase; S.Alb, serum albumin; TSB, total serum bilirubin.

Table 3 Diagnostic Abilities of Established and Proposed Criteria for Screening VNT in Children†

Criteria‡	Sn	Sp	PPV	NPV	LR+	LR-	Overall Accuracy
Baveno VI	0.6	0.92	0.6	0.93	8.4	0.43	0.87
Expanded Baveno VI	0.2	1	1	0.88	NA	0.80	0.87
TE (19)+PC (125)	0.6	0.86	0.43	0.93	4.2	0.47	0.81
TE (19)+PC(150)	0.8	0.86	0.5	0.96	5.6	0.23	0.84
TE (19)+PC (175)	1	0.79	0.45	1	4.67	0	0.82
TE (19)+PC (200)	1	0.79	0.45	1	4.67	0	0.82
TE (19)+PC (225)	1	0.79	0.45	1	4.67	0	0.82
TE (19)+PC (250)	1	0.79	0.45	1	4.67	0	0.82
+SD (13)+PC (125)	0.6	0.86	0.43	0.93	4.2	0.47	0.81
+SD (13)+PC (150)	0.8	0.86	0.5	0.96	5.6	0.23	0.84
+SD (13)+PC (175)	1	0.79	0.45	1	4.67	0	0.82
+SD (13)+PC (200)	1	0.79	0.45	1	4.67	0	0.82
+SD (13)+PC (225)	1	0.79	0.45	1	4.67	0	0.82
+SD (13)+PC (250)	1	0.79	0.45	1	4.67	0	0.83

Notes: †Values in decimals. ‡Values in parentheses for TE, SD and PC denote the respective values, with the unit of measurement being kPa for TE and ×10⁹ cells/L for PC.

Abbreviations: VNT, varices needing treatment; TE, transient elastography; SD, standard deviation of TE; PC, platelet count; Sn, sensitivity; Sp, specificity; PPV, positive predictive value; NPV, negative predictive value; LR+, positive likelihood ratio; LR−, negative likelihood ratio; NA, not applicable.

Figure 2 ROCs of the existing and proposed criteria for non-invasive screening of varices needing treatment (VNT) in a population aged less than 18 years.

Notes: Fitted AUROCs of Baveno VI, Expanded Baveno VI and Revised Baveno VI are 0.9, 0.85 and 0.94, respectively.