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Baveno V criteria predicted outcomes of GI bleeding linked to portal hypertension

The Baveno V criteria accurately predicted outcomes of acute gastrointestinal bleeding in patients with portal hypertension, according to findings in a prospective study.

“The purpose of this study was to validate the Baveno V criteria for failure to control bleeding based on repeated endoscopic findings on day 5 of an acute bleeding episode, and to determine the clinical usefulness of combined use of Baveno V and [Adjusted Blood Requirement Index] for better prediction of treatment failure,” the researchers wrote.

Researchers enrolled 246 patients with liver cirrhosis with acute bleeding associated with portal hypertension between January 2010 and October 2012. The mean age of the patients was 56.5 years, and 80.9% were men. The adjusted blood requirement index (ABRI) was configured using two hematocrit levels as the initial hematocrit, one at baseline (ABRI-A) and one before transfusion (ABRI-B), according to the research.

“The mortality rate for acute gastrointestinal bleeding in portal hypertension is highest during the first 5 days and declines gradually over the following 6 weeks,” the researchers wrote. “If treatments fail to control bleeding, additional treatment strategies need to be considered.”

Overall, 78.5% of all patients (n=193) experienced successful treatment after 5 days. However, 53 patients were considered treatment failures, and of these, 24 died during the 5-day period. Multivariate analysis showed Child-Turcotte-Pugh class C and a history of previous bleeding to be factors that affected acute GI bleeding (P<.05).

Baveno V criteria deemed 47 patients as treatment failures. However, repeated endoscopic findings identified 29 patients as treatment failures, according to the research. Baveno V criteria area under the receiver operating characteristic curve (AUROC) was 0.96; sensitivity was 83%; specificity was 98.4%; positive predictive value was 93.6%; negative predictive value was 95.5%; positive likelihood ratio was 53.41 and negative likelihood ratio was 0.17.

The AUROC of Baveno V criteria was greater than the AUROC of Baveno II/III (P<.0001) and AUROC of Baveno IV criteria (P=.0001), according to the research.

“This prospective study shows that Baveno V definitions and criteria, but not ABRI, can predict the outcome of acute gastrointestinal bleeding management in patients with portal hypertension during the initial stages,” the researchers concluded.

Disclosure: One researcher reports receiving grants from Ferring.