Furthermore, pulse and blood pressure may not always reflect hypovolaemia correctly, such as when terlipressin is administered, since this drug both decreases the pulse rate and increases systolic blood pressure substantially. Therefore, new definitions and criteria were formulated at a consensus meeting at Baveno IV, aimed at being more specific and closer to clinical practice . These new criteria did not take into account haemodynamic parameters, and a new index was introduced termed the adjusted blood requirement index ABRI , based on transfusion requirement adjusted by the haematocrit variation.
As stipulated by the Baveno IV report, these criteria would need validation. ABRI was calculated as: A retrospective analysis of data from a RCT suggested 0. Two single- centre studies with retrospective analyses on outcome of upper GI bleeding P1: Another study from Pakistan investigated whether ABRI could predict the seven days mortality in patients with variceal bleeding . The study was a placebo-controlled trial comparing factor VIIa with placebo in upper GI bleeding in patients with portal hypertension . Patients were included after first trial product administration.
The three experts used the trial database to assess Baveno IV status for failure to control bleeding for each patient. The baseline haematocrit for all the ABRI calculations was the closest to the first trial drug administration. Two different time points were used for the second haematocrit value to calculate ABRI: The study population comprised patients. Beyond chance interobserver agreement Kappa statistics for clinical judgment before consensus was as follows: The present data, although not validating ABRI, do not allow a conclusion to be made that another transfusion index with selection of other assessment time points or other criteria would have no validity in defining clinical P1: This needs a prospective study.
A French multicentre study applying frequent haematocrit measurements is ongoing. It is hoped that this will give data to justify and validate a transfusion index. Further studies are awaited in order to assess if a transfusion index adds any value to the other criteria. Conclusion New criteria for failure to control bleeding and failure to prevent rebleeding were proposed during the Baveno V conference.
The main issue is to assess whether a transfusion index ABRI or other could have any usefulness to better select patients with failure to control bleeding. Clinical applicability of this index will have to be determined, as well as whether it will be appropriate for randomized trials. Interactions of time events with prognostic factors will be of particular interest.
French Club for the Study of Portal Hypertension. N Engl J Med Report of the Baveno IV consensus workshop on methodology of diagnosis and therapy in portal hypertension. Croat Med J J Hepatol , Aug 12 [Epub ahead of print]. World J Gastroenterol Gastroenterol Clin Biol Report of the Baveno III consensus workshop on definitions, methodology and therapeutic strategies in portal hypertension. Thirty-three responses were received as some were not clinicians. The salient results are presented below. Failure to control bleeding Panellists were asked: Do you use definitions of Baveno IV to define failure to control acute bleeding in your clinical practice?
In those who did not use Baveno IV criteria, the following factors were used after admitting and starting treatment: In those who used Baveno IV criteria, the following components were used: Portal Hypertension V, 5th edition.
Edited by Roberto de Franchis. The panellists were then asked whether for RCTs, there was satisfaction regarding the use of the Baveno IV criteria defining failure to control acute variceal bleeding. There then followed a series of questions about transfusion: As can be seen in the diagram above, about half measured every six hours or less. Point of care testing: The next question was whether in clinical practice the panellists were con- fident of the criteria that they currently use for defining failure to control variceal bleeding.
HostGator - Hospedagem de Sites | Página não encontrada
Those who responded yes were then asked if they thought that the criteria they used were all objective or sometimes subjective such as overall status. As seen below most felt the evaluation was subjective. Those who were not happy with the criteria they were using were asked if other maybe more precise criteria might be used and whether they thought that these criteria might be difficult to define?
The answers below suggest most felt it would be difficult to define these new criteria. In the final question panellists were asked if they had taken part in any randomized trial on any aspect of acute variceal bleeding between — and —? The responses indicate there have been fewer trials recently. Failure to prevent rebleeding The question to the panellists was whether they used Baveno IV criteria to define rebleeding. As can be seen below, the problem, again, was the ABRI index.
The next question was when secondary prophylaxis was started. Description Every five years, hepatologists with an interest in portal hypertension high blood pressure in the portal vein , gather in Baveno, Italy, for the Baveno International Consensus Workshop on Portal Hypertension, attending workshops and examining the latest in clinical data and research on this condition.
This book documents the contents of the meeting so that practitioners who could not be present at the conference still have access to the proceedings. He has had over articles published and cited on PubMed. Since , he has organised the Baveno International Consensus Workshop on Portal Hypertension Congress, which is held every 5 years, the content of which is reflected in this book which is sponsored by Ferring pharmaceuticals and then distributed to members. Table of contents Contributors.
Introduction Baveno I to Baveno V. Questionnaire to the Expert Panel. Lecture 21 Antifibrotic Drugs Massimo Pinzani.