Haiyu Wang; Jinjun Chen

doi:10.3350/cmh.2025.0328

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Correspondence to editorial 3 on “Baveno VI-SSM stratifies the risk of portal hypertension-related events in patients with HBV-related cirrhosis”

Haiyu Wang^{1,2,3,4,5,6,7}

, Jinjun Chen^{1,2,3,4,5,6,7,8}

Clinical and Molecular Hepatology 2026;32(1):e65-e67.
Published online: March 31, 2025

DOI: https://doi.org/10.3350/cmh.2025.0328

¹Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China

²State Key Laboratory of Multi-organ Injury Prevention and Treatment, Guangzhou, China

³Key Laboratory of Infectious Diseases Research in South China (Southern Medical University), Ministry of Education, Guangzhou, China

⁴Guangdong Provincial Key Laboratory for Prevention and Control of Major Liver Diseases, Guangzhou, China

⁵Guangdong Provincial Clinical Research Center for Viral Hepatitis, Guangzhou, China

⁶Guangdong Institute of Hepatology, Guangzhou, China

⁷Guangdong Provincial Research Center for Liver Fibrosis Engineering and Technology, Guangzhou, China

⁸Department of Hepatology, Zengcheng Branch, Nanfang Hospital, Southern Medical University, Guangzhou, China

Corresponding author : Haiyu Wang Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, No 1838, Guangzhou Dadao Bei, Guangzhou 510515, China Tel: +86-20-62786737, Fax: +86-20-62786737, E-mail: 375612668@qq.com

Jinjun Chen Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, No 1838, Guangzhou Dadao Bei, Guangzhou 510515, China Tel: +86-20-62787423, Fax: +86-20-62787423, E-mail: chjj@smu.edu.cn

Editor: Han Ah Lee, Chung-Ang University College of Medicine, Korea

• Received: March 23, 2025 • Accepted: March 28, 2025

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abbreviations
REFERENCES

See the article "Refining portal hypertension assessment: The clinical significance of spleen stiffness measurement in the Baveno VII Era: Editorial on “Baveno VI-SSM stratifies the risk of portal hypertension-related events in patients with HBV-related cirrhosis”" on page 400.

Keywords: Baveno VI-SSM; Spleen stiffness measurement; Portal hypertension

Dear Editor,

We sincerely thank Dr. Song for his keen interest and in-depth interpretation of our study on the “Baveno VI-SSM stratifies the risk of portal hypertension-related events in patients with HBV-related cirrhosis” [1]. Dr. Song’s comments [2] not only provided us with valuable feedback but also further highlighted the importance of spleen stiffness measurement (SSM) in the assessment of portal hypertension, which has greatly encouraged us.

We strongly agree with Dr. Song’s insights in the editorial regarding the value of SSM in refining risk stratification and clinical decision-making. As Dr. Song pointed out, SSM not only reflects structural changes in the spleen but also captures dynamic hemodynamic alterations associated with portal hypertension [3], giving it a unique advantage in predicting high-risk varices [4-6], portal hypertension and decompensation [7,8]. This unique capability positions SSM as a promising marker for monitoring portal hypertension and assessing treatment response. We greatly appreciate Dr. Song’s recognition of our work in this area, particularly his positive feedback on the role of the Baveno VI-SSM model in improving the identification of low-risk patients.

At the same time, we also greatly appreciate Dr. Song’s objective analysis of the limitations of our study. The points raised by Dr. Song are indeed important areas that need attention and improvement in our research. We fully agree that the homogeneity of the study cohort (limited to patients with HBV-related cirrhosis) restricts the generalizability of our findings to other etiologies. In the future, we plan to expand the scope of our research to include patients with liver diseases of various etiologies, in order to validate the applicability of these cutoff values in a broader population. Additionally, we recognize that an analysis of the use of non-selective beta-blockers (NSBBs) is crucial to refine our study. We will carefully document and analyze the use of NSBBs in subsequent studies to more accurately assess their impact on patient outcomes.

Regarding the improvements in spleen stiffness measurement technology, we fully agree with Dr. Song’s perspective on the potential application of a 100 Hz dedicated spleen probe. Notably, studies have already demonstrated the potential of this high-frequency probe in enhancing measurement accuracy [9-12]. In future research, it would be valuable to analyze the prognostic significance of this new technology and perform a comparative analysis with the existing 50 Hz probe, to further optimize the clinical utility of SSM.

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

HBV

hepatitis B virus

NSBB

non-selective β-blocker

SSM

spleen stiffness measurement

REFERENCES

1. Wang H, Liang W, Zhou L, Song J, Wen B, Wu Q, et al. Baveno VI-SSM stratifies the risk of portal hypertension-related events in patients with HBV-related cirrhosis. Clin Mol Hepatol 2025;31:866-880.
PubMed
PMC
2. Song DS. Refining portal hypertension assessment: The clinical significance of spleen stiffness measurement in the Baveno VII Era: Editorial on “Baveno VI-SSM stratifies the risk of portal hypertension-related events in patients with HBV-related cirrhosis”. Clin Mol Hepatol 2026;32:400-402.
3. Dajti E, Ravaioli F, Zykus R, Rautou PE, Elkrief L, Grgurevic I, et al. 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-analysis. Lancet Gastroenterol Hepatol 2023;8:816-828.
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4. Wang H, Wen B, Chang X, Wu Q, Wen W, Zhou F, et al. Baveno VI criteria and spleen stiffness measurement rule out high-risk varices in virally suppressed HBV-related cirrhosis. J Hepatol 2021;74:584-592.
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5. Sharma P, Kirnake V, Tyagi P, Bansal N, Singla V, Kumar A, et al. Spleen stiffness in patients with cirrhosis in predicting esophageal varices. Am J Gastroenterol 2013;108:1101-1107.
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6. Wang H, Xi R, Song J, Wen B, Zhang Y, Zhou L, et al. Combined model with acoustic radiation force impulse to rule out high-risk varices in HBV-related cirrhosis with viral suppression. Dig Liver Dis 2023;55:1062-1071.
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7. Elkrief L, Rautou PE, Ronot M, Lambert S, Dioguardi Burgio M, Francoz C, et al. Prospective comparison of spleen and liver stiffness by using shear-wave and transient elastography for detection of portal hypertension in cirrhosis. Radiology 2015;275:589-598.
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8. Dajti E, Ravaioli F, Marasco G, Alemanni LV, Colecchia L, Ferrarese A, et al. A combined Baveno VII and spleen stiffness algorithm to improve the noninvasive diagnosis of clinically significant portal hypertension in patients with compensated advanced chronic liver disease. Am J Gastroenterol 2022;117:1825-1833.
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9. Jachs M, Odriozola A, Turon F, Moga L, Téllez L, Fischer P, et al. Spleen stiffness measurement by vibration-controlled transient elastography at 100 Hz for non-invasive predicted diagnosis of clinically significant portal hypertension in patients with compensated advanced chronic liver disease: a modelling study. Lancet Gastroenterol Hepatol 2024;9:1111-1120.
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10. Zhang X, Song J, Zhang Y, Wen B, Dai L, Xi R, et al. Baveno VII algorithm outperformed other models in ruling out high-risk varices in individuals with HBV-related cirrhosis. J Hepatol 2023;78:574-583.
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11. Zhang X, Zhou L, Liang W, Cheng X, He Q, Li H, et al. Identification of clinically significant portal hypertension in cACLD individuals with spleen stiffness measurement. Liver Int 2025;45:e16241.
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12. Zhang X, Wang H, Xie X, Song J, Zhang Y, Zhou D, et al. Outstanding feasibility of spleen stiffness measurement by 100-Hz vibration-controlled transient elastography. JGH Open 2023;7:387-392.
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Correspondence to letter to the editor on “Baveno VI-SSM stratifies the risk of portal hypertension-related events in patients with HBV-related cirrhosis”
Haiyu Wang, Jinjun Chen
Clinical and Molecular Hepatology.2026; 32(2): e238. CrossRef

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Correspondence to editorial 3 on “Baveno VI-SSM stratifies the risk of portal hypertension-related events in patients with HBV-related cirrhosis”

Clin Mol Hepatol. 2026;32(1):e65-e67. Published online March 31, 2025

DOI: https://doi.org/10.3350/cmh.2025.0328

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Correspondence to editorial 3 on “Baveno VI-SSM stratifies the risk of portal hypertension-related events in patients with HBV-related cirrhosis”

Clin Mol Hepatol. 2026;32(1):e65-e67. Published online March 31, 2025

DOI: https://doi.org/10.3350/cmh.2025.0328

Correspondence to editorial 3 on “Baveno VI-SSM stratifies the risk of portal hypertension-related events in patients with HBV-related cirrhosis”

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