Prevention of Decompensation in Compensated Cirrhosis: Non-Selective Beta-Blockers for Everyone? Sanchit Sharma, Dhiraj Tripathi EMJ Hepatology.2024; : 74. CrossRef
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Risk and predictors of hepatic decompensation in grey zone patients by the Baveno VII criteria: A competing risk analysis Huapeng Lin, Jimmy Che‐To Lai, Grace Lai‐Hung Wong, Adèle Delamarre, Sang Hoon Ahn, Guanlin Li, Beom Kyung Kim, Lilian Yan Liang, Hye Won Lee, Sherlot Juan Song, Henry Lik‐Yuen Chan, Vincent Wai‐Sun Wong, Victor de Lédinghen, Seung Up Kim, Terry Cheuk‐Fun Alimentary Pharmacology & Therapeutics.2023; 58(9): 920. CrossRef
Background/Aims The utility of Baveno-VII criteria of clinically significant portal hypertension (CSPH) to predict decompensation in compensated advanced chronic liver disease (cACLD) patient needs validation. We aim to validate the performance of CSPH criteria to predict the risk of decompensation in an international real-world cohort of cACLD patients.
Methods cACLD patients were stratified into three categories (CSPH excluded, grey zone, and CSPH). The risks of decompensation across different CSPH categories were estimated using competing risk regression for clustered data, with death and hepatocellular carcinoma as competing events. The performance of “treating definite CSPH” strategy to prevent decompensation using non-selective beta-blocker (NSBB) was compared against other strategies in decision curve analysis.
Results One thousand one hundred fifty-nine cACLD patients (36.8% had CSPH) were included; 7.2% experienced decompensation over a median follow-up of 40 months. Non-invasive assessment of CSPH predicts a 5-fold higher risk of liver decompensation in cACLD patients (subdistribution hazard ratio, 5.5; 95% confidence interval, 4.0–7.4). “Probable CSPH” is suboptimal to predict decompensation risk in cACLD patients. CSPH exclusion criteria reliably exclude cACLD patients at risk of decompensation, regardless of etiology. Among the grey zone, the decompensation risk was negligible among viral-related cACLD, but was substantially higher among the non-viral cACLD group. Decision curve analysis showed that “treating definite CSPH” strategy is superior to “treating all varices” or “treating probable CSPH” strategy to prevent decompensation using NSBB.
Conclusions Non-invasive assessment of CSPH may stratify decompensation risk and the need for NSBB in cACLD patients.
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