The 'Rule of Five' Baveno VII: LSM Thresholds for Clinically Significant Portal Hypertension
General Provisions
The Baveno VII consensus advances approaches to the non-invasive assessment of portal hypertension initiated in Baveno VI (de Franchis R, Baveno VI Faculty. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop. J Hepatol 2015;63:743–752). The 'Rule of Five' operates with liver stiffness measurement (LSM) thresholds of 10, 15, 20, and 25 kPa to stratify the risk of clinically significant portal hypertension (CSPH) in compensated progressive chronic liver disease.
According to the data provided in the excerpts, precise diagnostic interpretations of individual thresholds (10, 15, 20, 25 kPa) in the provided sources are not outlined [clarify].
Sequential Application of Criteria
It has been shown that the sequential application of Baveno VII criteria with additional non-invasive indicators improves the diagnosis of CSPH (Jachs M et al. The sequential application of Baveno VII Criteria and VITRO score improves diagnosis of clinically significant portal hypertension. Clin Gastroenterol Hepatol 2023;21:1854–1863).
Role of Spleen Stiffness Measurement
Spleen stiffness measurement (SSM) is considered an additional tool for diagnosing CSPH in patients with compensated progressive chronic liver disease; a systematic review with meta-analysis of individual patient data confirms its diagnostic accuracy (Dajti E et al. Accuracy of spleen stiffness measurement for the diagnosis of clinically significant portal hypertension. Lancet Gastroenterol Hepatol 2023;8:816–828).
Exclusion of High-Risk Varices
The combination of LSM and platelet count can be used to exclude high-risk esophageal varices (Ding NS et al. Liver stiffness plus platelet count can be used to exclude high-risk oesophageal varices. Liver Int 2016;36:240–245).
Frequently asked questions
What LSM thresholds are included in the 'Rule of Five' Baveno VII?
Thresholds of 10, 15, 20, and 25 kPa. Detailed interpretation of each threshold in the provided excerpts is not given [clarify].
Can spleen stiffness be used for diagnosing CSPH?
Yes, spleen stiffness measurement (SSM) has diagnostic accuracy for CSPH in patients with compensated progressive chronic liver disease (Dajti E et al., Lancet Gastroenterol Hepatol 2023).
Does the sequential application of criteria improve diagnosis?
Yes, the sequential application of Baveno VII criteria with the VITRO score improves the diagnosis of CSPH (Jachs M et al., Clin Gastroenterol Hepatol 2023).
How can high-risk esophageal varices be non-invasively excluded?
The combination of LSM and platelet count can be used to exclude high-risk esophageal varices (Ding NS et al., Liver Int 2016).
Ferraioli et al. WFUMB Guideline/Guidance on Liver Multiparametric Ultrasound – Part 1 (2024); Ferraioli et al. Liver Ultrasound Elastography: Update to WFUMB Guidelines (2018); Dietrich et al. EFSUMB Guidelines Update 2017; de Franchis R, Baveno VI, J Hepatol 2015;63:743–752; Jachs M et al. Clin Gastroenterol Hepatol 2023;21:1854–1863; Dajti E et al. Lancet Gastroenterol Hepatol 2023;8:816–828; Ding NS et al. Liver Int 2016;36:240–245.