Prognostication of Liver Disease Patients via the WFUMB ‘Rule‐of‐4’ Algorithm Using SSI ‐ 2D ‐ SWE ‐Based Liver Stiffness Measurement

作者：Christian Sebesta, Georg Kramer, Nina Dominik, Benedikt Hofer, Lorenz Balcar, Paul Thöne, Mathias Jachs, Lukas Hartl, Benedikt Simbrunner, Till Schöchtner, Friedrich Haimberger, Nicolas Balutsch, Albert F. Stättermayer, Michael Trauner, Mattias Mandorfer, Thomas Reiberger, DJ Bauer · 发表于：Liver International · 年份：2026 · DOI：10.1111/liv.70614 · 被引用次数：1 · 研究领域：Liver Disease Diagnosis and Treatment、Liver Disease and Transplantation、Hepatocellular Carcinoma Treatment and Prognosis

BACKGROUND: The World Federation for Ultrasound in Medicine and Biology (WFUMB) guidance update 2024 proposed a 'rule-of-4' using ARFI liver stiffness measurement (LSM) to stratify the risk of decompensation events. This rule identifies advanced chronic liver disease (ACLD) at a threshold of ≥ 13 kPa and indicates a high probability of clinically significant portal hypertension (CSPH) above 21 kPa. METHODS: We prospectively enrolled 187 patients undergoing same-day SSI-2D-LSM (Aixplorer SuperSonic Imagine) and hepatic venous pressure gradient (HVPG) measurement. Patients were stratified into three LSM groups < 13 kPa, 13-21 kPa and > 21 kPa and followed for decompensation events for 1 year (Y1). RESULTS: The cohort comprised 31 (16.6%) patients with LSM < 13 kPa (non-ACLD); 33 (17.6%) LSM 13-21 kPa (ACLD) and 123 (65.8%) LSM > 21 kPa (high CSPH probability). The corresponding median HVPG values were 5 [IQR: 3-7] vs. 10 [7-14] vs. 17 [13-21] mmHg, respectively, and the corresponding CSPH prevalence was 6.5%, 54.5% and 91.9%. In ROC analysis to predict CSPH, SSI-2D-LSM demonstrated high accuracy (AUC: 0.83). Validating the new WFUMB extension of the 'rule-of-4', the recommended > 21 kPa threshold identified CSPH with a specificity of 80.0% and a PPV of 83.1%. In competing risk analysis, the Y1-decompensation rate was 0%, 10% and 24.7% of patients in the < 13 kPa, 13-21 kPa and > 21 kPa groups, respectively. For prediction of Y1-decompensation risk in the compensated ACLD (cACLD...