Baveno VII Criteria — Compensated Advanced Chronic Liver Disease (cACLD)
Baveno VII consensus (de Franchis 2022) for non-invasive identification of cACLD and clinically significant portal hypertension (CSPH) using liver stiffness measurement (LSM) by transient elastography and platelet count. 'Rule of 5' for LSM categories.
Score interpretation
Without other known clinical or imaging signs, LSM < 10 kPa rules out compensated advanced chronic liver disease.
→ No surveillance for portal hypertension required. Manage underlying liver disease; lifestyle, alcohol cessation, weight.
LSM 10–15 kPa suggests cACLD (needs confirmation); with platelets ≥ 150 ×10⁹/L clinically significant portal hypertension is ruled out (sensitivity and negative predictive value > 90%).
→ No screening endoscopy needed; repeat LSM and platelet count every year. HCC surveillance if cirrhosis is confirmed.
The result meets neither the Baveno VII rule-out nor the rule-in criteria for CSPH.
→ Hepatology review; further assessment (e.g. HVPG or spleen stiffness where available). Screening endoscopy can be avoided if LSM < 20 kPa and platelets > 150 ×10⁹/L; otherwise endoscopy if a non-selective β-blocker is not started.
LSM 20–25 kPa with platelets < 150 ×10⁹/L, or 15–20 kPa with platelets < 110 ×10⁹/L: about 60% have CSPH.
→ Hepatology review; consider a non-selective β-blocker (carvedilol preferred) or further assessment; screening endoscopy if no β-blocker is started.
LSM ≥ 25 kPa rules in CSPH (specificity and positive predictive value > 90%) in viral, alcohol-related and non-obese (BMI < 30) NASH-related cACLD — high risk of decompensation.
→ Endoscopy may be deferred; start non-selective β-blocker (adults: carvedilol 6.25 mg BD preferred) for primary prevention of decompensation. Six-monthly HCC surveillance. Treat aetiology aggressively. Children: use a children's formulary.
Interpretation bands for the Baveno VII. Apply clinical judgement and local guidance.
References
Related
Curated clinical cross-links plus same-class fallbacks.
- Propranolol (Portal Hypertension) · Antihypertensive
- Carvedilol (Portal Hypertension) · Non-Selective Beta-Blocker with Alpha₁-Blocking Activity
- Methyldopa (Chronic Hypertension in Pregnancy) · Centrally Acting Antihypertensive
- Amlodipine · Dihydropyridine Calcium Channel Blocker — Raynaud's / Peripheral Vascular Disease / Hypertension
- Hydralazine · Direct-Acting Vasodilator — Hypertensive Emergency / Chronic Hypertension
- Selexipag · Pulmonary Arterial Hypertension
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.