Abstract
Objective: To develop a
novel non-invasive model for CSPH, and
investigate whether carvedilol
could reduce the risk of decompensation in patients with high-risk CSPH
stratified by the novel model.
Methods: International multicenter
observational study with a median
follow-up time of 38 months. Three cohorts were included in study from 6
countries. In this study, a total of 1,304 patients were fulfilled
diagnosis of liver cirrhosis. Patients were treated with carvedilol in
longitudinal carvedilol-treating cohort. The primary outcome was the
development of the first hepatic decompensation .
Results: Six studies
from the meta-analysis were involved (n=819), and LSM and platelet count
(PLT) were identified as independent risk factors of CSPH, with pooled
risk ratios of 1.10 (95% confidence interval [CI] 1.06-1.15) and
0.99 (95% CI 0.98-0.99). A novel model was established. In HVPG cohort
(n=151), the areas under the receiver operating characteristic curve
(AUC) of the novel model, ANTICIPATE model, and Baveno VII criteria for
CSPH 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). The novel model narrows down the grey zone to
22.5%, significantly lower than 50.3%, using Baveno VII criteria
(p<0.001). In follow-up cohort (n=1,102), the cumulative
incidences (1.7% vs 2.5% vs 15.8%) of decompensation events were
significantly different by using the novel model cutoff values of
>0, 0 to -0.68 (medium-risk), and <-0.68
(p<0.001). In the carvedilol-treating cohort, the patients
with high-risk CSPH stratified by the novel model (treating cohort,
n=51) had significantly lower rates of decompensation than those of
NSBBs untreated patients with high-risk CSPH (n=613 before propensity
score matching [PSM], n=102 after PSM, all p<0.05).
Conclusion: A novel model provides stratification for CSPH and
decompensation in patients with liver cirrhosis. Treatment with
carvedilol significantly reduces the risk of decompensation among
high-risk CSPH patients stratified by the novel model.