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首页> 外文期刊>Hepatology: Official Journal of the American Association for the Study of Liver Diseases >Multicenter Prospective Validation of the Baveno IV and Baveno II/III Criteria in Cirrhosis Patients With Variceal Bleeding
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Multicenter Prospective Validation of the Baveno IV and Baveno II/III Criteria in Cirrhosis Patients With Variceal Bleeding

机译：Baveno IV和Baveno II / III标准在肝硬化静脉曲张出血患者中的多中心前瞻性验证

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The criteria for defining failure to control bleeding in cirrhosis patients were introduced at the Baveno II/III meetings and were widely used as endpoints in clinical trials. Because they lacked specificity, the Baveno IV criteria were proposed in 2005 and slightly modified in 2010 (Baveno V). These criteria included a new index for patients undergoing transfusion, called adjusted-blood-requirement-index (ABRI=number of blood units/(final-initial hematocrit+0.01)), with a cutoff value of 0.75. In this multicenter prospective study, we sought to 1) validate the Baveno IV/V criteria; 2) compare them to the Baveno II/III criteria; 3) assess ABRI performance using a standardized calculation. The key inclusion criteria were: 1) variceal bleeding; 2) cirrhosis; 3) no need to modify the transfusion policy. The patients were classified according to the Baveno IV, V, and II/III criteria. The gold standard for failure during a 5-day period was the clinical judgment of three independent experts, blinded to the Baveno assessments. A total of 249 patients were included. The experts' agreement in clinical judgment of the failure was 80%. Failure occurred in 20.5% of patients; the c-statistics were 0.72 versus 0.64 and 0.65 for Baveno IV versus Baveno II/III and Baveno V criteria (P=0.001 for both). ABRI did not improve the diagnostic performance of the Baveno IV criteria. The Baveno IV, but not Baveno II/III, criteria independently predicted survival. Conclusion: The Baveno IV criteria demonstrated a higher accuracy than the Baveno II/III and Baveno V criteria for assessing failure to control bleeding and predicted survival independently. Together, our results show that ABRI is not a useful metric, and the Baveno IV criteria should replace the Baveno II/III criteria. (Hepatology 2015;61:1024-1032)
机译：在Baveno II / III会议上介绍了定义未能控制肝硬化患者出血的标准，并已广泛用作临床试验的终点。由于缺乏特异性，Baveno IV标准于2005年提出，2010年稍作修改（Baveno V）。这些标准包括针对输血患者的新指标，称为调整后的血液需求指标（ABRI =血液单位数量/（最终初始血细胞比容+0.01）），临界值为0.75。在这项多中心前瞻性研究中，我们寻求1）验证Baveno IV / V标准; 2）将它们与Baveno II / III标准进行比较; 3）使用标准化计算评估ABRI性能。关键纳入标准为：1）静脉曲张破裂出血; 2）肝硬化; 3）无需修改输血策略。根据Baveno IV，V和II / III标准对患者进行分类。在5天的时间内失败的黄金标准是三位独立专家对Baveno评估视而不见的临床判断。总共包括249位患者。临床专家对失败的判断同意率为80％。 20.5％的患者发生衰竭; Baveno IV与Baveno II / III和Baveno V标准的c统计量分别为0.72、0.64和0.65（两者均为P = 0.001）。 ABRI没有改善Baveno IV标准的诊断性能。 Baveno IV（而非Baveno II / III）标准独立地预测生存率。结论：在评估控制出血失败和独立预测生存方面，Baveno IV标准显示出比Baveno II / III和Baveno V标准更高的准确性。总之，我们的结果表明ABRI并不是有用的度量标准，Baveno IV标准应该替代Baveno II / III标准。 （肝病2015; 61：1024-1032）

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