Validation and expansion of Baveno VII recompensation criteria in patients with cirrhosis and curable liver disease

Abstract

Background and Aims

Baveno-VII consensus recently defined recompensation in patients with decompensated cirrhosis achieving etiological cure. However, incidence, predictors and clinical significance of recompensation are poorly known. This study aimed to evaluate the incidence and prognostic impact of recompensation in patients with decompensated cirrhosis.

Methods

Outpatients with cirrhosis and curable etiologies (alcohol, HCV, HBV) were consecutively included and followed up. Recompensation was defined according to Baveno VII criteria. Additionally, expanded recompensation criteria were evaluated for patients on low dose diuretics and/or lactulose/rifaximin for ≥12 months. In 160 patients, inflammatory cytokines (IL-6,IL-1β, IL-10) were measured in serum samples. An external cohort was used to validate study findings.

Results

298 out of 525 decompensated cirrhotic outpatients achieved an effective etiological treatment and 21 (7%) achieved recompensation (Baveno-VII criteria), while 112 patients achieved expanded recompensation criteria (37.6%). MELD score (sHR=0.89; p<0.001), BMI (sHR=0.93; p=0.020), hemoglobin (sHR=1.14; p=0.010) and further decompensation (sHR=0.50; p=0.001) were independent predictors of recompensation. In multivariable analysis, mortality risk was not significantly different between patients achieving recompensation and compensated patients (HR=0.97; p=0.947), while decompensated patients had the highest mortality risk (HR=4.96; p<0.001). Mortality risk was not significantly different between patients meeting expanded recompensation criteria and Baveno-VII criteria (HR=0.97; p=0.938). Serum IL-6, IL-1beta and IL-10 were significantly higher in decompensated patients than in compensated and recompensated patients.

Conclusion

Baveno-VII criteria identify cirrhotic patients with a good prognosis, but fewer than 10% of decompensated patients achieve recompensation. Expanding these criteria to include patients receiving minimal decompensation treatment identifies those with similarly low mortality risk.

Impact and implications

In recent years, growing evidence has shown that achieving an etiological cure can significantly improve the prognosis of decompensated patients, leading to the development of the concept of recompensation. Baveno VII recently proposed a definition for recompensation; however, data on the clinical impact of this condition remain limited. In this study we evaluated Baveno VII criteria and developed and validated expanded Baveno VII criteria for recompensation. Our findings demonstrates that recompensation is associated with improved survival, reduced hyperdynamic circulation and decreased systemic inflammation in outpatients with decompensated cirrhosis. These results are valuable for hepatologists and researchers aiming to refine patient management strategies and risk stratification in cirrhosis care.