Validation and expansion of Baveno VII recompensation criteria in patients with cirrhosis and curable liver disease

Abstract

Background & aims: The Baveno VII group recently proposed criteria to define recompensation in patients with decompensated cirrhosis achieving etiological cure. However, the incidence, predictors and clinical significance of recompensation are poorly understood. The aim of this study was to evaluate the incidence and prognostic impact of recompensation in patients with decompensated cirrhosis.

Methods: Outpatients with cirrhosis and curable etiologies (alcohol, HCV, HBV) were consecutively included and followed up. Recompensation was defined according to Baveno VII criteria. Additionally, expanded recompensation criteria were evaluated for patients on low-dose diuretics and/or lactulose/rifaximin for ≥12 months. In 160 patients, inflammatory cytokines (IL-6, IL-1β, IL-10) were measured in serum samples. An external cohort was used to validate study findings.

Results: Out of 525 outpatients with decompensated cirrhosis, 298 received effective etiological treatment and 21 (7%) achieved recompensation (Baveno VII criteria), while 112 patients achieved expanded recompensation criteria (37.6%). MELD score (subdistribution hazard ratio [sHR] 0.89; p <0.001), BMI (sHR 0.93; p = 0.020), hemoglobin (sHR 1.14; p = 0.010) and further decompensation (sHR 0.50; p = 0.001) were independent predictors of recompensation. In multivariable analysis, mortality risk was not significantly different between patients achieving recompensation and compensated patients (HR 0.97; p = 0.947), while decompensated patients had the highest mortality risk (HR 4.96; p <0.001). Mortality risk was not significantly different between patients meeting expanded recompensation criteria and Baveno VII criteria (HR 0.97; p = 0.938). Serum IL-6, IL-1β and IL-10 were significantly higher in decompensated patients than in compensated and recompensated patients.

Conclusion: Baveno VII criteria identify patients with cirrhosis and a good prognosis, but fewer than 10% of decompensated patients achieve recompensation. Expanding these criteria to include patients receiving minimal decompensation treatment identifies those with similarly low mortality risk.

Impact and implications: In recent years, growing evidence has shown that achieving an etiological cure can significantly improve the prognosis of patients with decompensated cirrhosis, leading to the concept of recompensation. The Baveno VII group recently proposed criteria to define recompensation; however, data on the clinical impact of this state remain limited. In this study we evaluated Baveno VII criteria and developed and validated expanded Baveno VII criteria for recompensation. Our findings demonstrate that recompensation is associated with improved survival, reduced hyperdynamic circulation and decreased systemic inflammation in outpatients with decompensated cirrhosis. These results are valuable for hepatologists and researchers aiming to refine patient management strategies and risk stratification in cirrhosis care.

Keywords: fibrosis; liver cirrhosis; portal hypertension; transplant.