Simple blood tests to diagnose compensated advanced chronic liver disease and stratify the risk of clinically significant portal hypertension

作者：Georg Semmler, Lukas Hartl, Yuly P. Mendoza, Benedikt Simbrunner, Mathias Jachs, Lorenz Balcar, Michael Schwarz, Benedikt Hofer, L. Fritz, Anna Schedlbauer, Katharina Stopfer, Daniela Neumayer, Jurij Maurer, Robin Szymanski, Elias Laurin Meyer, Bernhard Scheiner, Peter Quehenberger, Michael Trauner, Elmar Aigner, Annalisa Berzigotti, Thomas Reiberger, Mattias Mandorfer · 发表于：Hepatology · 年份：2024 · DOI：10.1097/hep.0000000000000829 · 被引用次数：22 · 研究领域：Liver Disease Diagnosis and Treatment、Liver Disease and Transplantation、Liver Diseases and Immunity

BACKGROUND AND AIMS: Compensated advanced chronic liver disease (cACLD) identifies patients at risk for clinically significant portal hypertension (CSPH), and thus, for liver-related complications. The limited availability of liver stiffness measurements (LSM) impedes the identification of patients at risk for cACLD/CSPH outside of specialized clinics. We aimed to develop a blood-based algorithm to identify cACLD by fibrosis-4 (FIB-4) and CSPH by von Willebrand factor/platelet count ratio (VITRO). APPROACH AND RESULTS: Patients with (suspected) compensated chronic liver disease undergoing FIB-4+LSM were included in the LSM/FIB-4 cohorts from Vienna and Salzburg. The HVPG/VITRO cohorts included patients undergoing HVPG-measurement + VITRO from Vienna and Bern.LSM/FIB-4-derivation-cohort: We included 6143 patients, of whom 211 (3.4%) developed hepatic decompensation. In all, 1724 (28.1%) had LSM ≥ 10 kPa, which corresponded to FIB-4 ≥ 1.75. Importantly, both LSM (AUROC:0.897 [95% CI:0.865-0.929]) and FIB-4 (AUROC:0.914 [95% CI:0.885-0.944]) were similarly accurate in predicting hepatic decompensation within 3 years. FIB-4 ≥ 1.75 identified patients at risk for first hepatic decompensation (5 y-cumulative incidence:7.6%), while in those <1.75, the risk was negligible (0.3%).HVPG/VITRO-derivation cohort: 247 patients of whom 202 had cACLD/FIB-4 ≥ 1.75 were included. VITRO exhibited an excellent diagnostic performance for CSPH (AUROC:0.889 [95% CI:0.844-0.934]), similar to LSM (AU...