Clinical Medicine & Physiology
Baveno VII Portal Hypertension (CSPH) Rule-Of-5 Criteria & ANTICIPATE Probability Formula
Stratify compensated advanced chronic liver disease (cACLD) patients for Clinically Significant Portal Hypertension (CSPH, HVPG >= 10 mmHg) and endoscopic screening avoidance using Baveno VII (2022) Transient Elastography LSM + Platelet criteria and the ANTICIPATE logistic score.
Replace invasive transjugular HVPG catheterization and unnecessary endoscopies with Baveno VII Rule-of-5!
Clinically Significant Portal Hypertension (CSPH, hepatic venous pressure gradient HVPG >= 10 mmHg) drives first hepatic decompensation (ascites, variceal hemorrhage, encephalopathy) in compensated cirrhosis! Standardized globally by the Baveno VI (2015) and Baveno VII (2022, Journal of Hepatology, de Franchis et al.) Consensus Workshops using Transient Elastography Liver Stiffness Measurement LSM (kPa) and Platelet Count PLT (x10^9/L = x10^3/uL):
(1) Screening Endoscopy Sparing (Baveno VI Criteria): patients with LSM < 20 kPa AND Platelets > 150 x10^9/L have < 5% risk of varices needing treatment and safely avoid screening endoscopy! (2) Baveno VII CSPH Rule-Out (> 90% sensitivity/NPV): LSM <= 15 kPa AND Platelets >= 150 x10^9/L rules OUT CSPH! (3) Baveno VII CSPH Rule-In (> 90% specificity/PPV -> initiate non-selective beta-blocker carvedilol prophylaxis!): LSM >= 25 kPa rules IN CSPH (in viral, alcohol, and non-obese NASH cACLD)! And in the 15–25 kPa gray zone, Abraldes et al.’s (2016) ANTICIPATE Model computes continuous CSPH probability via Logit = -6.332025 + 3.100060 * LN(LSM_kPa) - 0.020462 * Platelets_10e9!
| Baveno VII Non-Invasive Tier (Viral / Alcohol / Non-Obese cACLD) | LSM (kPa) & Platelet (x10^9/L) Thresholds | Clinical Management Action |
|---|---|---|
| Rule-Out cACLD | LSM < 10 kPa (Absence of clinical signs) | Very (< 1%) 3-yr decompensation risk |
| Rule-Out CSPH (> 90% NPV) | LSM <= 15 kPa AND Platelets >= 150 | CSPH Excluded; no beta-blocker needed |
| Endoscopy-Sparing Safe Zone | LSM < 20 kPa AND Platelets > 150 | Safely avoid screening upper endoscopy |
| Rule-In CSPH (> 90% PPV) | LSM >= 25 kPa | CSPH Confirmed (>= 10 mmHg); consider carvedilol |
Baveno VII CSPH & Endoscopy-Sparing Clinical Stratification Formula
Classifies patients from FibroScan Liver Stiffness Measurement LSM B2 (kPa) and Platelet Count B3 (x10^9/L) across Baveno VII Rule-In, Gray-Zone, Endoscopy-Sparing, and Rule-Out tiers.
=IF(OR(B2 <= 1, B2 > 75, B3 <= 5, B3 > 1000), "Invalid Liver Stiffness LSM (1–75 kPa) or Platelets (5–1,000 x10^9/L)", IF(B2 >= 25, "Rule-In CSPH (LSM >= 25 kPa, >90% PPV)", IF(AND(B2 <= 15, B3 >= 150), "Rule-Out CSPH (LSM <= 15 kPa & PLT >= 150, >90% NPV)", IF(AND(B2 < 20, B3 > 150), "CSPH Gray Zone — Baveno VI Endoscopy-Sparing (<20 kPa & PLT >150)", "Indeterminate CSPH Gray Zone — Evaluate ANTICIPATE / Spleen Stiffness"))))ANTICIPATE Study Continuous CSPH Probability (%) from LSM & Platelets
Evaluates 100 / (1 + EXP(-(-6.332025 + 3.10006 * LN(LSM_kPa) - 0.020462 * Platelets))) to resolve Baveno VII gray-zone risk (e.g., >= 60% actionable threshold).
=IF(OR(B2 <= 1, B2 > 75, B3 <= 5, B3 > 1000), "Invalid LSM or Platelets", ROUND(100 / (1 + EXP(-(-6.332025 + 3.10006 * LN(B2) - 0.020462 * B3))), 1))Try the example
Use the original values or change them to test your understanding.