Model validation in international HVPG cohort
In the HVPG cohort, the ROC of the novel CSPH risk model was shown in Figure 2. The AUC were 0.91 (95% CI 0.86-0.95), 0.80 (95% CI 0.73-0.87), and 0.83 (95% CI 0.77-0.89) for the CSPH risk model, ANTICIPATE model, and Baveno VII criteria, respectively (Figure 2, Table 2). In addition, the AUC of CSPH risk model for assessing CSPH is 0.86 (0.78-0.94) and 0.96 (0.91-1.00) in viral cohort and non-viral cohort, respectively (sFigure 4). According to the NPV and PPV >90%, the cutoff value of >0 (high-risk) and < -0.68 (low-risk) were used to rule in and rule out CSPH, respectively. Notably, the novel model cut off value of >0 (high-risk) with a higher PPV of 0.906 and a specificity of 0.918 rules in 42.3% of patients with high-risk CSPH, which is higher than the 19.2% of Baveno VII criteria (Table 2). Similar performances were also observed for ruling out of patients with low-risk (Table 2). Notably, the novel model narrows down the grey zone to 22.5%, which is significantly lower than 50.3%, using Baveno VII criteria (Table 2).
Model validation of decompensation incidences in the international follow-up cohort
Overall, there were 248 (22.5%), 241 (21.9%), and 613 (55.6%) cirrhotic patients were categorized into low-risk, medium-risk and high-risk CSPH groups based on the novel model. Over a median follow-up of 39.0 (25.2-55.2) months, the 3-year cumulative incidences of decompensation among the follow-up cohort was substantially higher in the high-risk CSPH group (15.8%) as compared to the low-risk CSPH (1.7%) or medium-risk CSPH group (2.5%) without NSBBs treatment (p<0.001) (Figure 3). Moreover, the 3-year and 5-year AUCs of the CSPH risk model were higher than that of ANTICIPATE model and Baveno VII criteria (sFigure 5).