Adding 100 Hz Spleen Stiffness Measurement to the Baveno VII Model Improves Decompensation Risk Prediction in cACLD

BACKGROUND AND AIMS: Recent evidence has shown that spleen stiffness measurement (SSM), assessed with a spleen-dedicated elastography device (100 Hz probe), can enhance the diagnosis of clinically significant portal hypertension (CSPH) in patients with compensated advanced chronic liver disease (cACLD). This study aimed to evaluate the value of 100 Hz-SSM, alone or in combination with liver stiffness measurement (LSM) for predicting hepatic decompensation. METHODS: We retrospectively screened consecutive patients referred for elastography between June 2020 and April 2023. All patients with cACLD, defined as an LSM ≥ 10 kPa, were included. Baseline data (elastography, laboratory, demographic and clinical information) were collected, and liver-related events were recorded from the first LSM/SSM assessment until death, liver transplantation, transjugular intrahepatic portosystemic shunt (TIPS) placement or last follow-up. RESULTS: A total of 371 patients with cACLD were included. Over a median follow-up of 35 months (IQR 28-43), hepatic decompensation occurred in 8.4%. Both LSM and SSM predicted hepatic decompensation (C-index: LSM = 0.79, 95% CI 0.71-0.85; SSM = 0.70, 95% CI 0.59-0.80). Accuracy increased when combined with BMI and platelets into the NICER (Non-Invasive CSPH Estimated Risk) model (C-index: NICER = 0.84, 95% CI 0.78-0.90; vs. LSM p = 0.165 or SSM p < 0.001). The Baveno VII model combined with SSM divided the cohort into three groups with significantly increasing risks of decompensation (rule-out: 1.6%, grey zone: 7.2%, rule-in: 22.4%, p < 0.001). CONCLUSIONS: LSM and 100 Hz-SSM are valuable tools for assessing decompensation risk in a real-life multi-etiological cACLD population, particularly when incorporated into risk estimation models such as the NICER model or Baveno VII ± SSM model.