Refining the Baveno VI elastography criteria for the definition of compensated advanced chronic liver disease.

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The Baveno VI consensus proposed a dual liver stiffness (LS) by transient elastography threshold of <10 and >15 kPa for excluding and diagnosing compensated advanced chronic liver disease (cACLD), in the absence of other clinical signs. We validated these criteria in a real-world multicentre study.We included 5648 patients (mean age 51±13 years, 53% males) from ten European liver centres who had a liver biopsy and LS measurement within 6 months. We included patients with chronic hepatitis C (CHC, n=2913, 52%), non-alcoholic fatty liver disease (NAFLD, n=1073, 19%), alcohol-related liver disease (ALD, n=946, 17%) or chronic hepatitis B (CHB, n=716, 13%). cACLD was defined as fibrosis stage ≥F3.Overall, 3606 (66%) and 987 (18%) patients had LS <10 and >15 kPa, respectively, while cACLD was histologically confirmed in 1772 (31%) patients. The cut-offs of <10 and >15 kPa showed 75% sensitivity and 96% specificity to exclude and diagnose cACLD, respectively. Examining the ROC curve, a more optimal dual cut-off at <7 and >12 kPa, with 91% sensitivity and 92% specificity for excluding and diagnosing cACLD (AUC=0.87, 95%CI:0.86-0.88, P<0.001) was derived. Specifically for ALD and NAFLD, a low cut-off of 8 kPa can be used (sensitivity=93%). For the unclassified patients, we derived a risk model based on common patient characteristics with better discrimination than LS alone (AUC=0.74 vs. 0.69, P<0.001).Instead of the Baveno VI proposed <10 and >15 kPa dual cut-offs, we found that the <8 kPa (or <7 kPa for viral hepatitis) and >12 kPa dual cut-offs have better diagnostic accuracy in cACLD.

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