Validation of Baveno VI Criteria for ...
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Article dans une revue scientifique: Article original
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Title :
Validation of Baveno VI Criteria for Screening and Surveillance of Esophageal Varices in Patients with Compensated Cirrhosis and a Sustained Response to Antiviral Therapy.
Author(s) :
Thabut, Dominique [Auteur]
Bureau, Christophe [Auteur]
Université Toulouse III - Paul Sabatier [UT3]
Layese, Richard [Auteur]
Université Paris-Est Créteil Val-de-Marne - Paris 12 [UPEC UP12]
Mahuas-Bourcier, Valerie [Auteur]
Université Paris 13 [UP13]
Hammouche, Maryam [Auteur]
Université Paris 13 [UP13]
Cagnot, Carole [Auteur]
Marcellin, Patrick [Auteur]
Guyader, Dominique [Auteur]
Pol, Stanislas [Auteur]
Université Paris Descartes - Paris 5 [UPD5]
Larrey, Dominique [Auteur]
De Ledinghen, Victor [Auteur]
Ouzan, Denis [Auteur]
Zoulim, Fabien [Auteur]
Roulot, Dominique [Auteur]
Tran, Albert [Auteur]
Université de Nice Sophia-Antipolis [UNSA]
Bronowicki, Jean-Pierre [Auteur]
Zarski, Jean-Pierre [Auteur]
Goria, Odile [Auteur]
Cales, Paul [Auteur]
Peron, Jean-Marie [Auteur]
Alric, Laurent [Auteur]
Bourliere, Marc [Auteur]
Mathurin, Philippe [Auteur]
Lille Inflammation Research International Center - U 995 [LIRIC]
Blanc, Jean-Frederic [Auteur]
Abergel, Armand [Auteur]
Serfaty, Lawrence [Auteur]
Mallat, Ariane [Auteur]
Université Paris-Est Créteil Val-de-Marne - Paris 12 [UPEC UP12]
Grange, Jean-Didier [Auteur]
Attali, Pierre [Auteur]
Bacq, Yannick [Auteur]
Wartelle-Bladou, Claire [Auteur]
Dao, Thong [Auteur]
Pilette, Christophe [Auteur]
Silvain, Christine [Auteur]
Christidis, Christos [Auteur]
Capron, Dominique [Auteur]
Bernard-Chabert, Brigitte [Auteur]
Hillaire, Sophie [Auteur]
Di Martino, Vincent [Auteur]
Sutton, Angela [Auteur]
Audureau, Etienne [Auteur]
Université Paris-Est Créteil Val-de-Marne - Paris 12 [UPEC UP12]
Roudot-Thoraval, Francoise [Auteur]
Université Paris-Est Créteil Val-de-Marne - Paris 12 [UPEC UP12]
Nahon, Pierre [Auteur]
Université Paris 13 [UP13]
Fontaine, Helene [Auteur]
Leroy, Vincent [Auteur]
Riachi, Ghassan [Auteur]
Dharancy, Sebastien [Auteur]
Lille Inflammation Research International Center - U 995 [LIRIC]
Thiefin, Gerard [Auteur]
Bureau, Christophe [Auteur]
Université Toulouse III - Paul Sabatier [UT3]
Layese, Richard [Auteur]
Université Paris-Est Créteil Val-de-Marne - Paris 12 [UPEC UP12]
Mahuas-Bourcier, Valerie [Auteur]
Université Paris 13 [UP13]
Hammouche, Maryam [Auteur]
Université Paris 13 [UP13]
Cagnot, Carole [Auteur]
Marcellin, Patrick [Auteur]
Guyader, Dominique [Auteur]
Pol, Stanislas [Auteur]
Université Paris Descartes - Paris 5 [UPD5]
Larrey, Dominique [Auteur]
De Ledinghen, Victor [Auteur]
Ouzan, Denis [Auteur]
Zoulim, Fabien [Auteur]
Roulot, Dominique [Auteur]
Tran, Albert [Auteur]
Université de Nice Sophia-Antipolis [UNSA]
Bronowicki, Jean-Pierre [Auteur]
Zarski, Jean-Pierre [Auteur]
Goria, Odile [Auteur]
Cales, Paul [Auteur]
Peron, Jean-Marie [Auteur]
Alric, Laurent [Auteur]
Bourliere, Marc [Auteur]
Mathurin, Philippe [Auteur]
Lille Inflammation Research International Center - U 995 [LIRIC]
Blanc, Jean-Frederic [Auteur]
Abergel, Armand [Auteur]
Serfaty, Lawrence [Auteur]
Mallat, Ariane [Auteur]
Université Paris-Est Créteil Val-de-Marne - Paris 12 [UPEC UP12]
Grange, Jean-Didier [Auteur]
Attali, Pierre [Auteur]
Bacq, Yannick [Auteur]
Wartelle-Bladou, Claire [Auteur]
Dao, Thong [Auteur]
Pilette, Christophe [Auteur]
Silvain, Christine [Auteur]
Christidis, Christos [Auteur]
Capron, Dominique [Auteur]
Bernard-Chabert, Brigitte [Auteur]
Hillaire, Sophie [Auteur]
Di Martino, Vincent [Auteur]
Sutton, Angela [Auteur]
Audureau, Etienne [Auteur]
Université Paris-Est Créteil Val-de-Marne - Paris 12 [UPEC UP12]
Roudot-Thoraval, Francoise [Auteur]
Université Paris-Est Créteil Val-de-Marne - Paris 12 [UPEC UP12]
Nahon, Pierre [Auteur]
Université Paris 13 [UP13]
Fontaine, Helene [Auteur]
Leroy, Vincent [Auteur]
Riachi, Ghassan [Auteur]
Dharancy, Sebastien [Auteur]
Lille Inflammation Research International Center - U 995 [LIRIC]
Thiefin, Gerard [Auteur]
Journal title :
Gastroenterology
Abbreviated title :
Gastroenterology
Volume number :
156
Pages :
997-1009
Publication date :
2019-03
ISSN :
1528-0012
English keyword(s) :
Portal Hypertension
Variceal Bleeding
Esophagus
Elastometry
Variceal Bleeding
Esophagus
Elastometry
HAL domain(s) :
Sciences du Vivant [q-bio]
English abstract : [en]
Management of patients with cirrhosis includes endoscopic screening and surveillance to detect esophageal varices (EV) and prevent bleeding. However, the Baveno VI guidelines recommend avoiding endoscopies for patients ...
Show more >Management of patients with cirrhosis includes endoscopic screening and surveillance to detect esophageal varices (EV) and prevent bleeding. However, the Baveno VI guidelines recommend avoiding endoscopies for patients with liver stiffness measurements below 20 kPa and platelet counts above 150,000 (favorable Baveno VI status) and endoscopic assessment of patients with higher levels of liver stiffness and platelet counts (unfavorable Baveno VI status). We aimed to validate the Baveno VI guidelines, evaluating outcomes of patients in the ANRS-CO12 CirVir cohort with compensated cirrhosis associated with hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, with or without a sustained response to antiviral therapy. We performed an ancillary study using data from 891 patients in the ANRS CO12 CirVir cohort, treated at 35 centers in France, with HCV or HBV infection and biopsy-proven cirrhosis, Child-Pugh A scores, no previous complications, and no hepatocellular carcinoma who underwent an endoscopic procedure and had interpretable liver stiffness measurements and platelet counts. Progression of portal hypertension (PHT) was defined as the onset of varices needing treatment (VNT) or PHT-related bleeding. An sustained response to antiviral therapy was defined as undetectable level of HCV RNA by polymerase chain reaction assay (<50 IU/mL) 12 weeks after the end of treatment (SVR) or an undetectable level of HBV DNA. The primary aims were to validate the Baveno VI guidelines for screening and surveillance of EV in patients with compensated cirrhosis and to study the effects of an SVR on the progression of PHT. A total of 200 patients achieved an SVR (22.4%) (94 patients with HCV infection, 98 patients with HBV infection, and 8 patients with both); 80 of these patients had favorable Baveno VI status and none had VNT. Progression of PHT was studied in 548 patients; during a follow-up period of 61.2 months (interquartile range, 39.5-80.6 months), 105 of these patients (19.1%) had progression of PHT. Lack of an SVR and grade 1 EV were independently associated with progression of PHT. At the time of PHT progression, all patients had unfavorable Baveno VI status. Achieving favorable Baveno VI status after an SVR was associated with the absence of PHT progression. Favorable Baveno VI status and SVR were independently associated with survival. In an analysis of data from a large cohort of patients with HBV- or HCV-associated cirrhosis in France, we validated the Baveno VI guidelines on screening and surveillance of PHT, even for patients who achieved a sustained response to antiviral therapy.Show less >
Show more >Management of patients with cirrhosis includes endoscopic screening and surveillance to detect esophageal varices (EV) and prevent bleeding. However, the Baveno VI guidelines recommend avoiding endoscopies for patients with liver stiffness measurements below 20 kPa and platelet counts above 150,000 (favorable Baveno VI status) and endoscopic assessment of patients with higher levels of liver stiffness and platelet counts (unfavorable Baveno VI status). We aimed to validate the Baveno VI guidelines, evaluating outcomes of patients in the ANRS-CO12 CirVir cohort with compensated cirrhosis associated with hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, with or without a sustained response to antiviral therapy. We performed an ancillary study using data from 891 patients in the ANRS CO12 CirVir cohort, treated at 35 centers in France, with HCV or HBV infection and biopsy-proven cirrhosis, Child-Pugh A scores, no previous complications, and no hepatocellular carcinoma who underwent an endoscopic procedure and had interpretable liver stiffness measurements and platelet counts. Progression of portal hypertension (PHT) was defined as the onset of varices needing treatment (VNT) or PHT-related bleeding. An sustained response to antiviral therapy was defined as undetectable level of HCV RNA by polymerase chain reaction assay (<50 IU/mL) 12 weeks after the end of treatment (SVR) or an undetectable level of HBV DNA. The primary aims were to validate the Baveno VI guidelines for screening and surveillance of EV in patients with compensated cirrhosis and to study the effects of an SVR on the progression of PHT. A total of 200 patients achieved an SVR (22.4%) (94 patients with HCV infection, 98 patients with HBV infection, and 8 patients with both); 80 of these patients had favorable Baveno VI status and none had VNT. Progression of PHT was studied in 548 patients; during a follow-up period of 61.2 months (interquartile range, 39.5-80.6 months), 105 of these patients (19.1%) had progression of PHT. Lack of an SVR and grade 1 EV were independently associated with progression of PHT. At the time of PHT progression, all patients had unfavorable Baveno VI status. Achieving favorable Baveno VI status after an SVR was associated with the absence of PHT progression. Favorable Baveno VI status and SVR were independently associated with survival. In an analysis of data from a large cohort of patients with HBV- or HCV-associated cirrhosis in France, we validated the Baveno VI guidelines on screening and surveillance of PHT, even for patients who achieved a sustained response to antiviral therapy.Show less >
Language :
Anglais
Audience :
Internationale
Popular science :
Non
Administrative institution(s) :
CHU Lille
Inserm
Université de Lille
Inserm
Université de Lille
Submission date :
2019-10-22T08:16:51Z
2024-01-30T09:38:01Z
2024-01-30T09:38:01Z