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How to clarify the Baveno VI criteria for ruling out varices needing treatment by noninvasive tests
Author(s) -
Calès Paul,
Buisson François,
Ravaioli Federico,
Berger Arthur,
Carboni Carlotta,
Marasco Giovanni,
Festi Davide
Publication year - 2019
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.13945
Subject(s) - contingency table , medicine , population , sensitivity (control systems) , predictive value , statistics , mathematics , environmental health , electronic engineering , engineering
Background & Aims Baveno VI criteria enabled the screening of varices needing treatment ( VNT ) without endoscopy but created confusion by not stating the method used to calculate the 5% missed VNT limit, resulting in different calculations across validation studies. We analysed those calculations to clarify their diagnostic meaning. Methods (a) Literature review and recalculation of the missed VNT rates according to the three definitions encountered. (b) Contingency table comparison of these latter to determine their diagnostic meanings. (c) Real case analysis. 4/Simulation of variations in the three main statistical descriptors ( VNT , missed VNT or spared endoscopies). Results Missed VNT rates in the three definitions varied five‐ to 10‐fold across 7 papers. The contingency table showed that the definitions based on VNT prevalence and spared endoscopy as reference corresponded, respectively, to sensitivity and negative predictive value ( NPV ). The whole population‐based definition corresponded to diagnostic accuracy (not pertinent in that setting). Real case analysis showed that concerning liver stiffness, the 95% sensitivity and NPV cut‐offs for VNT were, respectively, 14.1 and 26.5 kP a. The VNT ‐based definition offered a more statistically powerful paired comparison between diagnostic tests, whereas the definition based on spared endoscopies was hampered by an unpaired comparison. Case simulation showed that the VNT ‐based definition was the most sensitive to descriptor variations. Conclusion The definitions of missed VNT rate placing VNT or spared endoscopy as the denominator are appropriate, providing, respectively, sensitivity and NPV for VNT . We privilege the first since it corresponds to the true proportion of missed VNT .