title: Prospective validation of Baveno V definitions and criteria for failure to control bleeding in portal hypertension.
abstract: New definitions and criteria were released at the Baveno V consensus meeting. The purposes of this study were to verify Baveno V definitions and criteria for failure to control bleeding and to determine the usefulness of the combined use of the Adjusted Blood Requirement Index [ABRI: (number of blood units)/(final hematocrit-initial hematocrit)+0.01] with Baveno V criteria. In all, 246 consecutive liver cirrhosis patients with acute bleeding associated with portal hypertension were enrolled prospectively between January 2010 and October 2012. The treatment outcome on day 5 was assessed by endoscopy. For the ABRI calculation, two hematocrit levels were used as the initial hematocrit: the first level measured upon patient arrival (ABRI-A) and the lowest level measured before transfusion (ABRI-B). Treatment failures were identified in 53 patients, of whom 24 died. Based on repeated endoscopic findings, 29 patients were identified as treatment failures, while according to Baveno V criteria, 47 patients were regarded as treatment failures. The area under the receiver operating characteristic curve (AUROC) of Baveno V criteria was 0.906, and the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio were 83.0%, 98.4%, 93.6%, 95.5%, 53.41, and 0.17, respectively. The AUROC of Baveno V criteria was significantly greater than those of Baveno IV (P=0.0001) and Baveno II/III (P<0.0001) criteria. Adding ABRI-A or -B to Baveno V criteria resulted in a significant reduction of the AUROC (P<0.05).
  
  
  CONCLUSIONS
  The Baveno V criteria are good predictors of treatment failure of early-stage acute gastrointestinal bleeding in patients with portal hypertension, while the addition of ARBI does not improve the prediction accuracy of the outcome of bleeding.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
authors.forename: Sun Young
authors.initials: SY
authors.lastname: Ahn
authors.forename: Soo Young
authors.initials: SY
authors.lastname: Park
authors.forename: Won Young
authors.initials: WY
authors.lastname: Tak
authors.forename: Yu Rim
authors.initials: YR
authors.lastname: Lee
authors.forename: Eun Jeong
authors.initials: EJ
authors.lastname: Kang
authors.forename: Jung Gil
authors.initials: JG
authors.lastname: Park
authors.forename: Won Kee
authors.initials: WK
authors.lastname: Lee
authors.forename: Kwan
authors.initials: K
authors.lastname: Lee
authors.forename: Young Oh
authors.initials: YO
authors.lastname: Kweon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017211:Treatment Failure