How to clarify the Baveno VI criteria for ruling out varices needing treatment by noninvasive tests
| Autor: | Davide Festi, Carlotta Carboni, Paul Calès, Giovanni Marasco, Federico Ravaioli, François Buisson, Arthur Berger |
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| Přispěvatelé: | Calès, Paul, Buisson, Françoi, Ravaioli, Federico, Berger, Arthur, Carboni, Carlotta, Marasco, Giovanni, Festi, Davide |
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Liver Cirrhosis
Population Paired comparison Esophageal and Gastric Varices 03 medical and health sciences 0302 clinical medicine Liver stiffness Statistics Humans Medicine Endoscopy Digestive System Baveno VI criteria education Statistical descriptors Contingency table education.field_of_study Hepatology business.industry noninvasive diagnosi sensitivity Predictive value 030220 oncology & carcinogenesis Elasticity Imaging Techniques 030211 gastroenterology & hepatology oesophageal varice Varices business Algorithms Case analysis |
| Popis: | 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 kPa. 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. |
| Databáze: | OpenAIRE |
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