Spleen stiffness to identify clinically significant portal hypertension

The presence of clinically significant portal hypertension (defined by a hepatic venous pressure gradient >10 mm Hg) in patients with compensated advanced chronic liver disease (ACLD) identifies a subgroup of patients who are at increased risk of decompensation and developing hepatocellular carcinoma. 1 Ripoll C Groszmann R Garcia-Tsao G et al. Hepatic venous pressure gradient predicts clinical decompensation in patients with compensated cirrhosis. Gastroenterology. 2007; 133: 481-488 Summary Full Text Full Text PDF PubMed Scopus (819) Google Scholar , 2 Ripoll C Groszmann RJ Garcia-Tsao G et al. Hepatic venous pressure gradient predicts development of hepatocellular carcinoma independently of severity of cirrhosis. J Hepatol. 2009; 50: 923-928 Summary Full Text Full Text PDF PubMed Scopus (316) Google Scholar Use of carvedilol reduces portal pressure in these patients, decreases the incidence of first decompensation, and improves survival. 3 Villanueva C Albillos A Genescà J et al. β blockers to prevent decompensation of cirrhosis in patients with clinically significant portal hypertension (PREDESCI): a randomised, double-blind, placebo-controlled, multicentre trial. Lancet. 2019; 393: 1597-1608 Summary Full Text Full Text PDF PubMed Scopus (300) Google Scholar , 4 Villanueva C Torres F Sarin SK et al. Carvedilol reduces the risk of decompensation and mortality in patients with compensated cirrhosis in a competing-risk meta-analysis. J Hepatol. 2022; 77: 1014-1025 Summary Full Text Full Text PDF PubMed Scopus (28) Google Scholar A non-invasive method to identify the presence of clinically significant portal hypertension is urgently needed to be able to select this at-risk group. To be clinically useful, this method should be easily accessible, including to non-hepatologists such as general practitioners and primary care physicians, and should identify the at-risk group in patients with a wide range of cirrhosis aetiologies, including non-alcoholic steatohepatitis. Accuracy of spleen stiffness measurement for the diagnosis of clinically significant portal hypertension in patients with compensated advanced chronic liver disease: a systematic review and individual patient data meta-analysisAlgorithms combining Baveno VII criteria with SSM showed good performance and reduced the diagnostic grey zone for clinically significant portal hypertension compared with Baveno VII criteria alone. Future studies should evaluate whether SSM-based diagnosis allows for the identification of patients who would benefit from non-selective β-blocker treatment. Full-Text PDF