Baveno VI-SSM stratifies the risk of portal hypertension-related events in patients with HBV-related cirrhosis

Abstract

Background & aims: Cirrhotic patients with liver stiffness measurement (LSM) <20kPa and platelet count ≥150/ul (Baveno VI criteria), otherwise spleen stiffness measurement (SSM) ≤ 40kPa (Baveno VI-SSM criteria) can avoid endoscopy screening, however, no prospective data for their hepatic outcomes.

Methods: Compensated cirrhosis with chronic hepatitis B were prospectively enrolled from April 2019 to April 2022 and followed until July 2023. All patients underwent LSM, SSM and esophagogastroduodenoscopy (EGD) assessment.

Results: Among 1224 patients enrolled with median follow-up of 30 months (IQR 21-42), the incidence of decompensation was greater in 560 patients with unfavored Baveno-VI criteria (0.5 vs. 20.4 per 1,000 person-years, p=0.0004) than that in 664 patients with favored Baveno-VI-SSM criteria. The Baveno VI-SSM model identified more patients (54.2%) into low-risk for decompensation than Baveno VII-SSM model (single cutoff) (48.4%, p=0.004) and than Baveno VI criteria (34.6%, p<0.0001) did. Patients with high-risk varices diagnosed via endoscopy following Baveno VI-SSM model assessment had greater probability of decompensation compared to those identified by the Baveno VII-SSM model (single cutoff) (42.8 vs. 21.1 per 1,000 person-years, p=0.0088). Additionally, among the 493 patients who underwent endoscopic re-assessment, 242 patients with favored Baveno VI-SSM criteria had much lower incidence of EV progression (2.6 vs. 99.5 per 1,000 person-years, p=0.0004) and lower risk of decompensation compared to 140 patients with unfavored Baveno VI-SSM model (0 vs. 34.2 per 1,000 person-years, p=0.0256).

Conclusions: Baveno VI-SSM model could identify chronic hepatitis B-related cirrhosis patients at low risk of decompensation, which was greatly improved upon Baveno VI-SSM reassessment.