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Validation of Baveno VI Criteria for Screening and Surveillance of Esophageal Varices in Patients With Compensated Cirrhosis and a Sustained Response to Antiviral Therapy

Abstract

BACKGROUND & AIMS: 

Management of patients with cirrhosis includes endoscopic screening and surveillance to detect esophageal varices (EV) and prevent bleeding. However, the Baveno VI guidelines recommend avoiding endoscopies for patients with liver stiffness measurements below 20 kPa and platelet counts above 150,000 (favorable Baveno VI status) and endoscopic assessment of patients with higher levels of liver stiffness and platelet counts (unfavorable Baveno VI status). We aimed to validate the Baveno VI guidelines, evaluating outcomes of patients in the ANRS-CO12 CirVir cohort with compensated cirrhosis associated with hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, with or without a sustained response to antiviral therapy.

 

METHODS: 

We performed an ancillary study using data from 891 patients in the ANRS CO12 CirVir cohort, treated at 35 centers in France, with HCV or HBV infection and biopsy-proven cirrhosis, Child-Pugh A scores, no previous complications, and no hepatocellular carcinoma who underwent an endoscopic procedure and had interpretable liver stiffness measurements and platelet counts. Progression of portal hypertension (PHT) was defined as the onset of varices needing treatment (VNT) or PHT-related bleeding. An sustained response to antiviral therapy was defined as undetectable level of HCV RNA by polymerase chain reaction assay (<50 IU/mL) 12 weeks after the end of treatment (SVR) or an undetectable level of HBV DNA. The primary aims were to validate the Baveno VI guidelines for screening and surveillance of EV in patients with compensated cirrhosis and to study the effects of an SVR on the progression of PHT.

 

RESULTS: 

A total of 200 patients achieved an SVR (22.4%) (94 patients with HCV infection, 98 patients with HBV infection, and 8 patients with both); 80 of these patients had favorable Baveno VI status and none had VNT. Progression of PHT was studied in 548 patients; during a follow-up period of 61.2 months (interquartile range, 39.5-80.6 months), 105 of these patients (19.1%) had progression of PHT. Lack of an SVR and grade 1 EV were independently associated with progression of PHT. At the time of PHT progression, all patients had unfavorable Baveno VI status. Achieving favorable Baveno VI status after an SVR was associated with the absence of PHT progression. Favorable Baveno VI status and SVR were independently associated with survival.

 

CONCLUSIONS: 

In an analysis of data from a large cohort of patients with HBV- or HCV-associated cirrhosis in France, we validated the Baveno VI guidelines on screening and surveillance of PHT, even for patients who achieved a sustained response to antiviral therapy.

Authors

Thabut D1, Bureau C2, Layese R3, Bourcier V4, Hammouche M4, Cagnot C5, Marcellin P6, Guyader D6, Pol S7, Larrey D8, De Lédinghen V9, Ouzan D10, Zoulim F11, Roulot D12, Tran A13, Bronowicki JP14, Zarski JP15, Goria O16, Calès P17, Péron JM18, Alric L19, Bourlière M20, Mathurin P21, Blanc JF22, Abergel A23, Serfaty L24, Mallat A3, Grangé JD25, Attali P26, Bacq Y27, Wartelle-Bladou C28, Dao T29, Pilette C30, Silvain C31, Christidis C32, Capron D33, Bernard-Chabert B34, Hillaire S35, Di Martino V36, Sutton A37, Audureau E3, Roudot-Thoraval F3, Nahon P4; ANRS CO12 CirVir group.

 

Collaborators (38) Gastroenterology. 2019 Feb 13. pii: S0016-5085(18)35303-4. doi: 10.1053/j.gastro.2018.11.053. [Epub ahead of print]

Author Information

  1. AP-HP, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Service d'Hépatogastroentérologie, Paris; Sorbonne Universités, UPMC Université Paris 06, INSERM UMR_S 938/CDR Saint-Antoine and Institute of Cardiometabolism and Nutrition (ICAN), F-75012 Paris. Electronic address: dominique.thabut@aphp.fr.

  2. Service d'hépato-gastroentérologie, Hôpital Purpan CHU Toulouse, 31059 Toulouse Cedex; Université Paul Sabatier Toulouse III, Toulouse.

  3. AP-HP, Hôpital Henri Mondor, Service de Santé Publique, Unité de Recherche Clinique (URC Mondor), and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Ageing) Unit EA7376, UPEC, F-94000, Créteil.

  4. AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, Université Paris 13, Bobigny et INSERM U1162, Université Paris 5, Paris.

  5. ANRS (France Recherche Nord & sud Sida-HIV Hépatites), Paris; (8)AP-HP, Hôpital Beaujon, Service d'Hépatologie, Clichy.

  6. CHU Pontchaillou, Service d'Hépatologie, Rennes.

  7. AP-HP, Hôpital Cochin, Département d'Hépatologie et INSERM UMS20, Institut Pasteur, Université Paris Descartes, Paris.

  8. Hôpital Saint Eloi, Service d'Hépatologie, Montpellier.

  9. Hôpital Haut-Lévêque, Service d'Hépatologie, Bordeaux.

  10. Institut Arnaud Tzanck, Service d'Hépatologie, St Laurent du Var.

  11. Hôpital Hôtel Dieu, Service d'Hépatologie, Lyon.

  12. AP-HP, Hôpital Avicenne, Service d'Hépatologie, Bobigny.

  13. CHU de Nice, Service d'Hépatologie, et INSERM U1065, Université de Nice-Sophia-Antipolis, Nice.

  14. Hôpital Brabois, Service d'Hépatologie, Vandoeuvre-les-Nancy.

  15. Hôpital Michallon, Service d'Hépatologie, Grenoble.

  16. Hôpital Charles-Nicolle, Service d'Hépatologie, Rouen.

  17. CHU d'Angers, Service d'Hépatologie, Angers.

  18. Hôpital Purpan, Service d'Hépatologie, Toulouse.

  19. CHU Toulouse, Service de Médecine Interne-Pôle Digestif UMR 152, Toulouse.

  20. Hôpital Saint Joseph, Service d'Hépatologie, Marseille.

  21. Hôpital Claude Huriez, Service d'Hépatologie, Lille.

  22. Hôpital Haut-Lévêque, CHU Bordeaux, Pessac.

  23. Hôpital Hôtel Dieu, Service d'Hépatologie, Clermont-Ferrand.

  24. AP-HP, Hôpital Saint-Antoine, Service d'Hépatologie, Paris.

  25. AP-HP, Hôpital Tenon, Service d'Hépatologie, Paris.

  26. AP-HP, Hôpital Paul Brousse, Service d'Hépatologie, Villejuif.

  27. Hôpital Trousseau, Unité d'Hépatologie, CHRU de Tours.

  28. Hôpital d'Aix-En-Provence, Service d'Hépatologie, Aix-En-Provence.

  29. Hôpital de la Côte de Nacre, Service d'Hépatologie, Caen.

  30. CHU Le Mans, Service d'Hépatologie, Le Mans.

  31. CHU de Poitiers, Service d'Hépatologie, Poitiers.

  32. Institut Mutualiste Montsouris, Service d'Hépatologie, Paris.

  33. Hôpital Amiens Nord, Service d'Hépatologie, Amiens.

  34. Hôpital Robert Debré, Service d'Hépatologie, Reims.

  35. Hôpital Foch, Service de médecine interne, Suresnes.

  36. Hôpital Jean Minjoz, Service d'Hépatologie, Besançon.

  37. CRB (liver disease biobank) Groupe Hospitalier Paris Seine-Saint-Denis BB-0033-00027; AP-HP, Hôpital Jean Verdier, Service de Biochimie, Bondy; Inserm U1148, Université Paris 13, Bobigny, France.

  38. AP-HP, Hôpital Beaujon, Service d'Hépatologie, Clichy.

  39. AP-HP, Hôpital Cochin, Département d'Hépatologie et INSERM UMS20 et U1223, Institut Pasteur, Université Paris Descartes, Paris.

  40. Hôpital St André, Service d'Hépatologie, Bordeaux.

  41. AP-HP, Hôpital Henri Mondor, Service d'Hépatologie, Créteil.

  42. UPMC, AP-HP, Groupe Hospitalier de La Pitié-Salpêtrière, Service d'Hépatologie, Paris.

  43. Hôpital Foch, Service de médecine intrene, Suresnes.

  44. Hôpital Jean Minjoz, Service d'Hépatologie, Besançon, France.

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