Dear Editor,
We appreciate the insightful editorial comments on our recent publication [
1] by He, Dong and Qi [
2] which comprehensively described the strengths, concerns, and suggestions for future research direction. In this correspondence, we address and discuss the issues raised by the author.
Our findings demonstrated that this model spares 54.2% of patients from unnecessary endoscopy while maintaining a decompensation rate of only 0.6 per 1,000 person-years in the low-risk group. These results align with recent studies advocating for the integration of spleen stiffness measurement (SSM) into non-invasive algorithms to reduce diagnostic uncertainty in the “grey zone” of portal hypertension [
3]. Furthermore, endoscopy assessment following Baveno VI-SSM model would more specifically identify high-risk patients for decompensation compared with other non-invasive models did. In addition, reassessment of Baveno VI-SSM is more accurate in stratifying patients at low risk of EV progression and decompensation.
We greatly appreciate the positive recognition our study has received, particularly regarding the potential application of the Baveno VI-SSM model in risk stratification for HBV-related cirrhosis. We fully agree with the editorial's emphasis on the model’s potential in non-invasive management of portal hypertension, as well as its value in optimizing clinical monitoring and treatment strategies. We believe that with further validation and application, this model will provide significant support for personalized care of cirrhotic patients.
At the same time, we acknowledge the research limitations mentioned in the editorial, and we find these insights to be highly instructive for our future scientific endeavors. We fully agree that the homogeneity of the study cohort, the limited follow-up duration, and the optimization of spleen stiffness measurement methods are areas that require focused attention and improvement in our future research. Additionally, we will further investigate the impact of antiviral treatment on the model’s performance, with the aim of providing more targeted recommendations for clinical practice.
Although the Baveno VII consensus [
4] recommends primary prevention treatment for patients with portal hypertension, even the most effective carvedilol. As highlighted, approximately 25% of patients fail to achieve an hepatic venous pressure gradient (HVPG) response (defined as a ≥10% reduction from baseline or HVPG <12 mmHg) [
4-
7]. We appreciate the editorial’s emphasis on the critical need to identify non-responders to carvedilol therapy, a challenge that undermines the clinical utility of non-selective β-blocker (NSBBs) in portal hypertension management. In future research, it is crucial to explore SSM-based models to identify patients who may benefit from NSBB treatment.
In future research, we plan to expand the study cohort to include cirrhotic patients with a variety of underlying causes, in order to validate the generalizability of the Baveno VI-SSM model. Additionally, we will extend the follow-up period to more comprehensively assess the long-term trajectory of liver-related events. We will also investigate the use of a dedicated 100 Hz spleen probe for SSM, which is expected to improve measurement accuracy [
8-
10]. This is particularly relevant as spleen-specific probes were not widely available in hospitals at the start of our study. We believe that through these improvements, our research will provide stronger support for clinical practice.
FOOTNOTES
-
Authors’ contribution
Jinjun Chen: review and edit; Haiyu Wang: writing of the article, review and edit.
-
Acknowledgements
Prof Jinjun Chen is supported by National Key Research and Development Program of China (2022YFC2304800), Nat ional Science and Technology Major Project (2018ZX10723203), National Natural Science Foundation of China (82070650, 82370614), Local Innovative and Research Teams Project of Guangdong Pearl River Talents Program (2017BT01S131), Clinical Research Program of Nanfang Hospital, Southern Medical University (2018CR037, 2020CR026), Clinical Research Start-up Program of Southern Medical University by High-level University Construction Funding of Guangdong Provincial Department of Education (LC2019ZD006), President Foundation of Nanfang Hospital, Southern Medical University (2019Z003) and Key-Area Research and Development Program of Guangdong Province (2019B020227004). Dr Haiyu Wang is supported by National Natural Science Foundation of China (82200674), National Postdoctoral Program for Innovative Talents of China (BX20220144) and Postdoctoral Science Foundation of China (2022M711518).
-
Conflicts of Interest
The authors have no conflicts to disclose.
Abbreviations
clinically significant portal hypertension
hepatic venous pressure gradient
spleen stiffness measurement
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