Modified and Alternative Baveno VI Criteria Based on Age for Ruling Out High-risk Varices in Patients With Compensated Cirrhosis

Abstract Background: The Baveno VI criteria(B6C) was recommended to screen high-risk varices(HRV) in liver cirrhosis patients so that esophagogastroduodenoscopy(EGD) could be safely avoided. It was perceived as conservative, and Transient elastography is not available in many medical institutions; this restricts the clinical application of B6C. We aimed to optimize the B6C to screen more patients who could safely avoid screening EGD and to explore the parameters to replace liver stiffness(LS).Methods: 1188 patients with compensated cirrhosis were analyzed and divided into the training cohort(TC) and validating cohort(VC) by the split-sample method. Variables were selected to construct the new criteria in the TC and were validated in the VC. Results: Age≥50 years, LS, platelet count(PLT), and spleen area (SA) were independently associated with HRV. The risk of HRV was 2.39 times higher in patients over 50 years, so the alternative B6C(AB6C) and modified B6C(MB6C) criteria were built based on age. MB6C was built by adjusting the cutoff value of LS and PLT (patients aged100×109/L and LS125×109/L and LS<20 kPa). The predicting performance HRV showed no statistical difference between PLT, SA and LS. SA was selected to replace the LS and built AB6C(patients aged100×109/L and SA<55cm2; aged≥50 years, combination of PLT>125×109/L and SA<44 cm2). Conclusions: The excellent performance of MB6C and AB6C, which stratified by age, were validated for safely ruling out high-risk varices and these could help avoid more EGD procedures than B6C and EB6C.Clinical trial registration number: ChiCTR-DDD-17013845.