Introduction
Although the hepatic venous pressure gradient (HVPG) is a gold standard, non-invasive tests are capable and widely used to identify clinically significant portal hypertension (CSPH) in patients with liver cirrhosis.1-3 According to the latest Baveno VII criteria, a liver stiffness measurement (LSM) value ≥25 kPa is sufficient to rule in CSPH, and LSM ≤15 kPa plus platelets (PLT) ≥150×109/L rules out CSPH.1 For the patients in the grey zone that did not meet the cutoff mentioned above values, a relatively complicated ANTICIPATE model was used, i.e., LSM values between 20-25 kPa plus PLT <150×109/L or LSM values between 15-20 kPa plus PLT <110×109/L, however, it can only predict CSPH risk of 60% or little higher.1,4 Notably, these non-invasive CSPH identification methods are not present as a continuous form that includes all combinations of LSM and PLT; for example, a patient with LSM of 18 kPa (or 10 kPa) plus PLT of 160×109/L (or 90×109/L) does not have a proper diagnostic scale.
More importantly, finding a diagnostic scale with a smaller grey zone is a reasonable and ongoing need. In the current study, we first perform a systemic review and meta-analysis to extract the significantly non-invasive risk factors of CSPH and then generate a novel model for the detection of CSPH. Secondly, the novel CSPH risk model was validated in two international multicenter cohorts containing cirrhotic patients, i.e., the cross-sectional HVPG-performed cohort for validation of diagnosis performance and the longitudinal follow-up cohort for prediction of cumulative decompensation events. Finally, we investigate whether carvedilol therapy could reduce the risk of hepatic decompensation in high-risk CSPH patients stratified by this novel CSPH risk model.