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.