A Combined Model of Spleen Stiffness and Baveno VII Criteria for Clinically Significant Portal Hypertension in Compensated Advanced Chronic Liver Disease: An International Multicenter Study
ABSTRACT Aims The renewing Baveno VII consensus proposed criteria for the diagnosis of clinically significant portal hypertension (CSPH) in patients with compensated advanced chronic liver disease (cACLD). The performance of a combined model of spleen stiffness measurement (SSM) by spleen‐dedicated...
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2025-03-01
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| Series: | Portal Hypertension & Cirrhosis |
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| Online Access: | https://doi.org/10.1002/poh2.70004 |
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| author | Chuan Liu Jie Li Ruiling He Ivica Grgurevic Ying Guo Shirong Liu Masashi Hirooka Yu Jun Wong Ling Yang Mislav Barisic Jaman Anita Madir Yohei Koizumi Yoichi Hiasa Jiacheng Liu Xiaoqing Guo Bo Gao Ning Liu Shanghao Liu Jianzhong Ma Liting Zhang Federico Ravaioli Antonio Colecchia Xiaolong Qi |
| author_facet | Chuan Liu Jie Li Ruiling He Ivica Grgurevic Ying Guo Shirong Liu Masashi Hirooka Yu Jun Wong Ling Yang Mislav Barisic Jaman Anita Madir Yohei Koizumi Yoichi Hiasa Jiacheng Liu Xiaoqing Guo Bo Gao Ning Liu Shanghao Liu Jianzhong Ma Liting Zhang Federico Ravaioli Antonio Colecchia Xiaolong Qi |
| author_sort | Chuan Liu |
| collection | DOAJ |
| description | ABSTRACT Aims The renewing Baveno VII consensus proposed criteria for the diagnosis of clinically significant portal hypertension (CSPH) in patients with compensated advanced chronic liver disease (cACLD). The performance of a combined model of spleen stiffness measurement (SSM) by spleen‐dedicated 100 Hz (SSM@100 Hz) or conventional 50 Hz (SSM@50 Hz) and Baveno VII criteria to rule‐in or rule‐out CSPH had not been well validated. This study aims to compare the performance of the combined model with Baveno VII criteria alone to rule‐in and rule‐out CSPH in cACLD. Methods This international multicenter study included cACLD patients who underwent paired liver stiffness measurement (LSM), SSM@100 Hz or SSM@50 Hz, platelet count (PLT), and hepatic venous pressure gradient (HVPG). CSPH was defined as HVPG ≥ 10 mmHg. Patients with SSM@100 Hz were prospectively recruited from China between August 2021 and March 2022, while a global cohort of patients with SSM@50 Hz from Croatia, Japan, and Singapore was retrospectively included between December 2014 and June 2022. The diagnostic performance of different models was assessed using sensitivity, specificity, positive predictive value, and negative predictive value. Results A total of 206 patients with cACLD were recruited from seven university centers and 110 patients were included in the final analysis (54 from the SSM@100 Hz cohort and 56 from the SSM@50 Hz cohort). The success rate of SSM@100 Hz was significantly higher than that of SSM@50 Hz (103/105 [98.1%] vs. 86/101 [85.1%]; p < 0.001). While the combined model (SSM > 50 kPa or LSM ≥ 25 kPa) and Baveno VII criteria (LSM ≥ 25 kPa) had a positive predictive value and specificity > 90% to rule‐in CSPH, the combined model correctly ruled‐in more cACLD patients with CSPH compared to Baveno VII criteria alone (35/110 [31.8%] vs. 22/110 [20.0%]; p < 0.001). Furthermore, the combined model (SSM < 21 kPa or [LSM ≤ 15 kPa and PLT ≥ 150 × 109/L]) and Baveno VII criteria (LSM ≤ 15 kPa and PLT ≥ 150 × 109/L) had a sensitivity and negative predictive value > 90% to rule‐out CSPH. Compared to the Baveno VII criteria alone, the combined model correctly ruled‐out more patients without CSPH, although there was no statistical difference (39/110 [35.5%] vs. 34/110 [30.9%]; p = 0.063). The findings remained broadly similar when subgroup analyses were performed in the SSM@100 Hz cohort and the SSM@50 Hz cohort. Notably, the combined model reduced patients in the gray zone compared to Baveno VII criteria alone (36/110 [32.7%] vs. 54/110 [49.1%]; p < 0.001). Conclusions Whether using SSM@100Hz or SSM@50Hz, the combined model of SSM and Baveno VII criteria was superior to Baveno VII criteria alone to rule‐in and rule‐out CSPH in cACLD patients, which may guide therapeutic decisions by minimizing cACLD patients in the gray zone. Trial Registration ClinicalTrials.gov; No.NCT05251272. |
| format | Article |
| id | doaj-art-b9dd723da85041ebbb382350d8b5622d |
| institution | OA Journals |
| issn | 2770-5838 2770-5846 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Wiley |
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| series | Portal Hypertension & Cirrhosis |
| spelling | doaj-art-b9dd723da85041ebbb382350d8b5622d2025-08-20T02:10:04ZengWileyPortal Hypertension & Cirrhosis2770-58382770-58462025-03-014141210.1002/poh2.70004A Combined Model of Spleen Stiffness and Baveno VII Criteria for Clinically Significant Portal Hypertension in Compensated Advanced Chronic Liver Disease: An International Multicenter StudyChuan Liu0Jie Li1Ruiling He2Ivica Grgurevic3Ying Guo4Shirong Liu5Masashi Hirooka6Yu Jun Wong7Ling Yang8Mislav Barisic Jaman9Anita Madir10Yohei Koizumi11Yoichi Hiasa12Jiacheng Liu13Xiaoqing Guo14Bo Gao15Ning Liu16Shanghao Liu17Jianzhong Ma18Liting Zhang19Federico Ravaioli20Antonio Colecchia21Xiaolong Qi22Liver Disease Center of Integrated Traditional Chinese and Western Medicine, Department of Radiology, Zhongda Hospital, Medical School Southeast University, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging & Interventional Radiology (Southeast University) Nanjing Jiangsu ChinaDepartment of Infectious Diseases, Nanjing Drum Tower Hospital The Affiliated Hospital of Nanjing University Medical School Nanjing Jiangsu ChinaDepartment of Ultrasound Donggang Branch the First Hospital of Lanzhou University Lanzhou Gansu ChinaUniversity Hospital Dubrava, University of Zagreb School of Medicine and Faculty of Pharmacy and Biochemistry Zagreb CroatiaDepartment of Hepatology The Third People's Hospital of Taiyuan Taiyuan Shanxi ChinaDepartment of Infectious Diseases Qufu People's Hospital Qufu Shandong ChinaDepartment of Gastroenterology and Metabology Ehime University Graduate School of Medicine Ehime JapanDepartment of Gastroenterology & Hepatology Changi General Hospital SingaporeLiver Disease Center of Integrated Traditional Chinese and Western Medicine, Department of Radiology, Zhongda Hospital, Medical School Southeast University, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging & Interventional Radiology (Southeast University) Nanjing Jiangsu ChinaDepartment of Gastroenterology, Hepatology and Clinical Nutrition University Hospital Dubrava Zagreb CroatiaDepartment of Gastroenterology, Hepatology and Clinical Nutrition University Hospital Dubrava Zagreb CroatiaDepartment of Gastroenterology and Metabology Ehime University Graduate School of Medicine Ehime JapanDepartment of Gastroenterology and Metabology Ehime University Graduate School of Medicine Ehime JapanDepartment of Infectious Diseases, Nanjing Drum Tower Hospital The Affiliated Hospital of Nanjing University Medical School Nanjing Jiangsu ChinaDepartment of Hepatology The Third People's Hospital of Taiyuan Taiyuan Shanxi ChinaMedical Laboratory, Qufu People's Hospital Qufu Shandong ChinaDepartment of Infectious Diseases Qufu People's Hospital Qufu Shandong ChinaLiver Disease Center of Integrated Traditional Chinese and Western Medicine, Department of Radiology, Zhongda Hospital, Medical School Southeast University, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging & Interventional Radiology (Southeast University) Nanjing Jiangsu ChinaDepartment of General Surgery The Third People's Hospital of Taiyuan Taiyuan Shanxi ChinaDepartment of Infectious Diseases The First Hospital of Lanzhou University Lanzhou Gansu ChinaGastroenterology Unit, Department of Medical Specialities University of Modena & Reggio Emilia, University Hospital of Modena Modena ItalyGastroenterology Unit, Department of Medical Specialities University of Modena & Reggio Emilia, University Hospital of Modena Modena ItalyLiver Disease Center of Integrated Traditional Chinese and Western Medicine, Department of Radiology, Zhongda Hospital, Medical School Southeast University, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging & Interventional Radiology (Southeast University) Nanjing Jiangsu ChinaABSTRACT Aims The renewing Baveno VII consensus proposed criteria for the diagnosis of clinically significant portal hypertension (CSPH) in patients with compensated advanced chronic liver disease (cACLD). The performance of a combined model of spleen stiffness measurement (SSM) by spleen‐dedicated 100 Hz (SSM@100 Hz) or conventional 50 Hz (SSM@50 Hz) and Baveno VII criteria to rule‐in or rule‐out CSPH had not been well validated. This study aims to compare the performance of the combined model with Baveno VII criteria alone to rule‐in and rule‐out CSPH in cACLD. Methods This international multicenter study included cACLD patients who underwent paired liver stiffness measurement (LSM), SSM@100 Hz or SSM@50 Hz, platelet count (PLT), and hepatic venous pressure gradient (HVPG). CSPH was defined as HVPG ≥ 10 mmHg. Patients with SSM@100 Hz were prospectively recruited from China between August 2021 and March 2022, while a global cohort of patients with SSM@50 Hz from Croatia, Japan, and Singapore was retrospectively included between December 2014 and June 2022. The diagnostic performance of different models was assessed using sensitivity, specificity, positive predictive value, and negative predictive value. Results A total of 206 patients with cACLD were recruited from seven university centers and 110 patients were included in the final analysis (54 from the SSM@100 Hz cohort and 56 from the SSM@50 Hz cohort). The success rate of SSM@100 Hz was significantly higher than that of SSM@50 Hz (103/105 [98.1%] vs. 86/101 [85.1%]; p < 0.001). While the combined model (SSM > 50 kPa or LSM ≥ 25 kPa) and Baveno VII criteria (LSM ≥ 25 kPa) had a positive predictive value and specificity > 90% to rule‐in CSPH, the combined model correctly ruled‐in more cACLD patients with CSPH compared to Baveno VII criteria alone (35/110 [31.8%] vs. 22/110 [20.0%]; p < 0.001). Furthermore, the combined model (SSM < 21 kPa or [LSM ≤ 15 kPa and PLT ≥ 150 × 109/L]) and Baveno VII criteria (LSM ≤ 15 kPa and PLT ≥ 150 × 109/L) had a sensitivity and negative predictive value > 90% to rule‐out CSPH. Compared to the Baveno VII criteria alone, the combined model correctly ruled‐out more patients without CSPH, although there was no statistical difference (39/110 [35.5%] vs. 34/110 [30.9%]; p = 0.063). The findings remained broadly similar when subgroup analyses were performed in the SSM@100 Hz cohort and the SSM@50 Hz cohort. Notably, the combined model reduced patients in the gray zone compared to Baveno VII criteria alone (36/110 [32.7%] vs. 54/110 [49.1%]; p < 0.001). Conclusions Whether using SSM@100Hz or SSM@50Hz, the combined model of SSM and Baveno VII criteria was superior to Baveno VII criteria alone to rule‐in and rule‐out CSPH in cACLD patients, which may guide therapeutic decisions by minimizing cACLD patients in the gray zone. Trial Registration ClinicalTrials.gov; No.NCT05251272.https://doi.org/10.1002/poh2.70004Baveno VII criteriaclinically significant portal hypertensioncompensated advanced chronic liver diseaseliver stiffness measurementspleen stiffness measurement |
| spellingShingle | Chuan Liu Jie Li Ruiling He Ivica Grgurevic Ying Guo Shirong Liu Masashi Hirooka Yu Jun Wong Ling Yang Mislav Barisic Jaman Anita Madir Yohei Koizumi Yoichi Hiasa Jiacheng Liu Xiaoqing Guo Bo Gao Ning Liu Shanghao Liu Jianzhong Ma Liting Zhang Federico Ravaioli Antonio Colecchia Xiaolong Qi A Combined Model of Spleen Stiffness and Baveno VII Criteria for Clinically Significant Portal Hypertension in Compensated Advanced Chronic Liver Disease: An International Multicenter Study Portal Hypertension & Cirrhosis Baveno VII criteria clinically significant portal hypertension compensated advanced chronic liver disease liver stiffness measurement spleen stiffness measurement |
| title | A Combined Model of Spleen Stiffness and Baveno VII Criteria for Clinically Significant Portal Hypertension in Compensated Advanced Chronic Liver Disease: An International Multicenter Study |
| title_full | A Combined Model of Spleen Stiffness and Baveno VII Criteria for Clinically Significant Portal Hypertension in Compensated Advanced Chronic Liver Disease: An International Multicenter Study |
| title_fullStr | A Combined Model of Spleen Stiffness and Baveno VII Criteria for Clinically Significant Portal Hypertension in Compensated Advanced Chronic Liver Disease: An International Multicenter Study |
| title_full_unstemmed | A Combined Model of Spleen Stiffness and Baveno VII Criteria for Clinically Significant Portal Hypertension in Compensated Advanced Chronic Liver Disease: An International Multicenter Study |
| title_short | A Combined Model of Spleen Stiffness and Baveno VII Criteria for Clinically Significant Portal Hypertension in Compensated Advanced Chronic Liver Disease: An International Multicenter Study |
| title_sort | combined model of spleen stiffness and baveno vii criteria for clinically significant portal hypertension in compensated advanced chronic liver disease an international multicenter study |
| topic | Baveno VII criteria clinically significant portal hypertension compensated advanced chronic liver disease liver stiffness measurement spleen stiffness measurement |
| url | https://doi.org/10.1002/poh2.70004 |
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