Diagnosis of clinically significant portal hypertension in patients with compensated advanced chronic liver disease

Although the concept of CSPH is HVPG-driven, non-invasive tests are sufficiently accurate to identify CSPH in clinical practice.

LSM by TE ≤15 kPa plus platelet count ≥150×109/L rules out CSPH (sensitivity and negative predictive value >90%) in patients with cACLD.

In patients with virus- and/or alcohol-related cACLD and non-obese (BMI <30 kg/m2) NASH-related cACLD, a LSM value by TE of ≥25 kPa is sufficient to rule in CSPH (specificity and positive predictive value >90%), defining the group of patients at risk of endoscopic signs of portal hypertension and at higher risk of decompensation.

In patients with virus- and/or alcohol-related and non-obese NASH-related cACLD with LSM values <25 kPa, the ANTICIPATE model can be used to predict the risk of CSPH. Based on this model, patients with LSM values between 20-25 kPa and platelet count <150×109/L or LSM values between 15-20 kPa and platelet count <110×109/L have a CSPH risk of at least 60%.

In patients with NASH-related cACLD, the ANTICIPATE-NASH model (including LSM, platelet count and BMI) may be used to predict the risk of CSPH, but further validation is needed.

References:

Corrigendum to ‘Baveno VII – Renewing consensus in portal hypertension’ [J Hepatol (2022) 959-974] Journal of Hepatology, Vol. 77, Issue 2