Refining the Baveno VII criteria for clinically significant portal hypertension : An individual patient data meta-analysis
Bañares, Juan (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Pons, Monica (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Reiberger, Thomas (Medical University of Vienna)
Mandorfer, Mattias (Medical University of Vienna)
Jachs, M. (Medical University of Vienna)
Semmler, Georg (Medical University of Vienna)
Colecchia, A. (University of Modena and Reggio Emilia)
Colecchia, L. (University of Modena and Reggio Emilia)
Dajti, E. (University of Bologna)
Bureau, C. (Université Paul Sabatier)
Larrue, Helene (Université Paul Sabatier)
Grgurević, I. (University Hospital Dubrava)
Fortea, Jose Ignacio (Hospital Universitario Marqués de Valdecilla (Santander, Cantabria))
Puente, Angela (Hospital Universitario Marqués de Valdecilla (Santander, Cantabria))
Berzigotti, A. (University of Bern)
Tsochatzis, Emmanuel A. (University College of London)
Bosch, Jaime (University of Bern)
Abraldes, Juan G. (University of Alberta)
Genescà Ferrer, Joan (Universitat Autònoma de Barcelona. Departament de Medicina)

Date:	2025
Abstract:	Background & Aims Clinically significant portal hypertension (CSPH) in compensated advanced chronic liver disease (cACLD) has major therapeutic implications. CSPH can be assessed using the Baveno VII criteria, though performance is reduced in patients with obesity (BMI ≥30 kg/m) and metabolic dysfunction-associated steatotic liver disease (MASLD). We aimed to validate the Baveno VII criteria and refine them using the ANTICIPATE ± NASH models. Methods We conducted a systematic review of studies validating the Baveno VII criteria for diagnosing CSPH, using hepatic venous pressure gradient as the reference standard. A search combining "CSPH" AND "Baveno VII" was performed from the Baveno VII consensus publication until June 2024. A meta-analysis evaluated the rule-in criterion (liver stiffness measurement [LSM] ≥25 kPa) and rule-out criterion (LSM ≤15 kPa + platelet count ≥150 × 10/L). We also assessed whether applying a ≥90% positive predictive value (PPV) risk threshold for CSPH, as predicted by ANTICIPATE ± NASH, improved diagnostic performance. Individual patient data were analyzed to evaluate model performance by center. Results Five studies including 1,433 patients with cACLD (CSPH prevalence 34-62%) of various etiologies were identified. The rule-in threshold of LSM ≥25 kPa achieved an overall pooled PPV of 92% across etiologies, except in MASLD with obesity. Applying a ≥75% CSPH risk threshold from the ANTICIPATE ± NASH models increased the PPV to 95%, including among patients with MASLD and obesity (PPV improved from 0. 67 to 0. 83; p <0. 001). The pooled negative predictive value for the rule-out criterion was 99% across all etiologies. ANTICIPATE ± NASH models performed consistently well across centers. Conclusion The Baveno VII criteria accurately classify CSPH across etiologies, except in MASLD with obesity. Incorporating a ≥75% risk threshold from the ANTICIPATE ± NASH models enhances diagnostic accuracy, particularly in MASLD with obesity, and may provide a simpler approach for identifying CSPH in clinical practice. Impact and implications This systematic review and meta-analysis confirm the validity of the Baveno VII criteria for both ruling out and ruling in clinically significant portal hypertension in patients with compensated advanced chronic liver disease. Applying a ≥75% risk threshold from the ANTICIPATE ± NASH models further improves overall diagnostic performance across etiologies. This provides a practical and accessible approach for hepatologists to identify candidates for prophylactic β-blocker therapy, as the calculation is based on simple clinical parameters - body mass index, liver stiffness, and platelet count - using an online calculator.
Grants:	Instituto de Salud Carlos III PI21/00691
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Language:	Anglès
Document:	Article ; recerca ; Versió acceptada per publicar
Subject:	Compensated advanced chronic liver disease ; Non-invasive tests ; Liver stiffness measurement ; Baveno VII ; Clinically significant portal hypertension
Published in:	Journal of hepatology, 2025 , ISSN 1600-0641

DOI: 10.1016/j.jhep.2025.10.014

Postprint 44 p, 1.3 MB

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