Liver and Bile
J Hepatol. 2024;80(5):744–52
Prognostic performance of non-invasive tests for portal hypertension is comparable to that of hepatic venous pressure gradient
Background and aims: Non-invasive tests to assess the probability of clinically significant portal hypertension (CSPH) – including the ANTICIPATE±NASH models based on liver stiffness measurement (LSM) and platelet count±body mass index, and the von Willebrand factor antigen to platelet count ratio (VITRO) – have fundamentally changed the management of compensated advanced chronic liver disease (cACLD). However, their prognostic utility has not been compared head-to-head to the gold standard for prognostication in cACLD, i.e. the hepatic venous pressure gradient (HVPG).
Methods: Patients with cACLD (LSM ≥ 10 kPa) who underwent advanced characterization via same-day HVPG/non-invasive test assessment from 2007 to 2022 were retrospectively included. Long-term follow-up data on hepatic decompensation was recorded.
Results: 420 patients with cACLD of varying etiologies, with a CSPH prevalence of 67.6%, were included. The cumulative incidence of hepatic decompensation at 1 and 2 years was 4.7% and 8.0%, respectively. HVPG, VITRO, and ANTICIPATE±NASH-CSPH probability showed similar time-dependent prognostic value (areas under the receiver-operating characteristic curve, 0.683–0.811 at 1 year and 0.699–0.801 at 2 years). In competing risk analyses adjusted for Model for End-stage Liver Disease score and albumin, HVPG (adjusted subdistribution hazard ratio [aSHR] = 1.099 [95% confidence interval {CI}: 1.054–1.150] per mmHg; p < 0.001), or VITRO (aSHR = 1.134 [95% CI: 1.062–1.211] per unit; p < 0.001), or ANTICIPATE±NASH-CSPH probability (aSHR = 1.232 [95% CI: 1.094–1.387] per 10%; p < 0.001) all predicted first decompensation during follow-up. Previously proposed cut-offs (HVPG ≥ 10 mmHg vs. < 10 mmHg, VITRO ≥ 2.5 vs. < 2.5, and ANTICIPATE-CSPH probability ≥ 60% vs. < 60%) all accurately discriminated between patients at negligible risk and those at substantial risk of hepatic decompensation.
Conclusions: The prognostic performance of ANTICIPATE±NASH-CSPH probability and VITRO is comparable to that of hepatic venous pressure gradient, supporting their utility for identifying patients who may benefit from medical therapies to prevent first hepatic decompensation.