Blood-based Vienna 3P/5P risk models accurately predict first hepatic decompensation in compensated advanced chronic liver disease

作者：Georg Kramer, Benedikt Simbrunner, Mathias Jachs, Lorenz Balcar, Benedikt Hofer, Nina Dominik, Lukas Hartl, Michael Schwarz, Georg Semmler, Christian Sebesta, Paul Thöne, S Geißelbrecht, Benjamin Maasoumy, Eduardo Cervantes‐Alvarez, Martin Sebastian McCoy, Oleksandr Petrenko, Jiří Reiniš, Philipp Schwabl, Albert Friedrich Stättermayer, M Trauner, Mattias Mandorfer, Thomas Reiberger · 发表于：JHEP Reports · 年份：2025 · DOI：10.1016/j.jhepr.2025.101642 · 被引用次数：2 · 研究领域：Liver Disease Diagnosis and Treatment、Liver Disease and Transplantation、Organ Transplantation Techniques and Outcomes

Background & Aims Invasive measurement of hepatic venous pressure gradient (HVPG) is the gold standard for diagnosing clinically significant portal hypertension (CSPH, i.e. HVPG ≥10 mmHg), which indicates an increased risk of decompensation. We evaluated the blood-based Vienna 3P/5P models for non-invasive assessment of portal hypertension (PH) severity and their prognostic value. Their performance was compared to HVPG, liver stiffness measurement (LSM) and the ANTICIPATE±NASH model. Methods Patients with compensated advanced chronic liver disease (cACLD) who underwent HVPG measurement and LSM within the prospective VICIS (Vienna Cirrhosis Study) were included. We assessed the ability of each model to detect CSPH and severe PH (HVPG ≥16 mmHg), predict decompensation, and stratify risk. Outcome prediction was further validated in an external cohort. Results Among 266 patients with diverse etiologies of cACLD, median HVPG was 11 (8-16) mmHg with a CSPH and severe PH prevalence of 62.8% and 25.6%, respectively. The 3P/5P models correlated with HVPG (both p < 0.001), achieving AUROCs of 0.704 (5P) for CSPH and 0.800 (5P) for severe PH prediction. During a median follow-up of 23.9 (15.3-32.6) months, 48 (18%) patients decompensated. HVPG and the 5P model showed similar time-dependent AUROCs (at 0.5 and 1 year: 0.753-0.822), superior to ANTICIPATE±NASH (AUROCs: 0.689-0.691) and LSM (AUROCs: 0.621-0.636). The 5P (adjusted subdistribution hazard ratio [aSHR]: 1.32, p < 0.001) and 3P ...