Document Detail


Diagnostic performance of Baveno IV criteria in cirrhotic patients with upper gastrointestinal bleeding: analysis of the F7 liver-1288 study population.
MedLine Citation:
PMID:  20817301     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND & AIMS: The definition of failure to control bleeding agreed upon at the Baveno IV consensus meeting, included the Adjusted Blood Requirement Index [ABRI: number of blood units/(final-initial hematocrit+0.01)]. ABRI ≥0.75 denotes failure. However, timing for hematocrit measurements was not defined. The aims of this study were: (1) to assess the Baveno IV criteria performance to classify treatment success or failure to control bleeding at 5 days, (2) to determine the appropriate timing for hematocrit.
METHODS: Two hundred and forty-two cirrhotic patients with gastrointestinal bleeding were independently classified by three clinical experts according to the Baveno IV criteria, by analysis of the database of a randomized trial. ABRI was calculated by using the closest hematocrit to the 5 day time point from the first trial product administration (ABRI-1) or after the latest transfusion within the 5-day period (ABRI-2). The gold standard for success/failure for 5-day control of bleeding was the clinical judgment of the three independent observers based on all the clinical and follow-up data.
RESULTS: Inter-observer agreement for the final outcome assessment was 0.82 and a final consensus was obtained in 236/242 patients. Inter-observer agreement on patient classification with Baveno IV criteria was 0.70 with ABRI-1 and 0.84 with ABRI-2. c-statistics for correct patients classification were 0.86 for ABRI-1, 0.84 for ABRI-2, and 0.88 for Baveno IV criteria without ABRI. ABRI-1 caused misclassification of 27 patients and ABRI-2 of 39.
CONCLUSIONS: Baveno IV criteria are accurate to assess outcome of patients with variceal bleeding. There is a substantial observer variability linked to timing of hematocrits for ABRI calculation. With the current definition ABRI does not add to the performance of the other criteria.
Authors:
D Thabut; G D'Amico; P Tan; R De Franchis; S Fabricius; D Lebrec; J Bosch; F Bendtsen
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial     Date:  2010-08-12
Journal Detail:
Title:  Journal of hepatology     Volume:  53     ISSN:  1600-0641     ISO Abbreviation:  J. Hepatol.     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-11-02     Completed Date:  2011-02-24     Revised Date:  2012-08-24    
Medline Journal Info:
Nlm Unique ID:  8503886     Medline TA:  J Hepatol     Country:  England    
Other Details:
Languages:  eng     Pagination:  1029-34     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
Affiliation:
UPMC, AP-HP, Service d'Hépato-Gastroentérologie, Hôpital Pitié-Salpêtrière, Paris, France.
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MeSH Terms
Descriptor/Qualifier:
Adult
Blood Transfusion
Esophageal and Gastric Varices / complications
Factor VIIa / therapeutic use
Female
Gastrointestinal Hemorrhage / blood,  complications*,  diagnosis*,  therapy
Hematocrit
Humans
Hypertension, Portal / complications
Liver Cirrhosis / complications*
Male
Middle Aged
Recombinant Proteins / therapeutic use
Retrospective Studies
Time Factors
Treatment Failure
Treatment Outcome
Chemical
Reg. No./Substance:
0/Recombinant Proteins; 0/recombinant FVIIa; EC 3.4.21.21/Factor VIIa

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