Prospective study on the application of the Baveno II Consensus Conferencecriteria in patients with cirrhosis and gastrointestinal bleeding

Background/Aims: This study aimed to evaluate the Baveno II criteria defini ng key events in variceal bleeding. Methods: These criteria were applied to 196 patients with cirrhosis admitte d for upper gastrointestinal bleeding due to portal hypertension and enroll ed in a trial. Blood pressure, heart rate, hematocrit and clinical signs of upper digestive tract hemorrhage were recorded for 5 days. The blind overa ll clinical judgment of hemodynamic stability was recorded separately by th e Steering Committee. Results: The evaluation of several hemodynamic criteria was left to the jud gment of the clinician, The first time point for the control of bleeding, f ixed at 6 h after admission, was impractical since 13% of the patients had not yet received specific treatment. The independent judgment did not agree in 38% of 82 cases without control of bleeding. In 15% of cases this was d ue to tachycardia, Calculation of several judgment criteria was not defined in the Baveno II criteria: survival without bleeding at 5 days, transfusio n rate, and length of hospital stay. Conclusions: Although the Baveno II criteria have improved the definitions of key events, the criteria are hampered by limits such as false positive c riteria of failure to control bleeding. We make several proposals for impro vement.