Liver stiffness can predict decompensation and need for beta-blockers in compensated cirrhosis: a step beyond Baveno-VI criteria
Related Experiment Video
Updated: Oct 5, 2025
Measurement of Liver Stiffness Using Atomic Force Microscopy Coupled with Polarization Microscopy
Published on: July 20, 2022
Ankur Jindal1, Sanchit Sharma2, Samagra Agarwal1
1Department of Hepatology and Liver Transplantation, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
Insights
Liver stiffness measurement (LSM) alone is a viable alternative to Baveno-VI criteria (B6C) and hepatic venous pressure gradient (HVPG) for guiding beta-blocker therapy in compensated cirrhosis patients, potentially preventing decompensation.
Area of Science:
- Hepatology
- Gastroenterology
- Non-invasive diagnostics
Background:
- Advanced compensated cirrhosis patients risk clinical decompensation.
- Liver stiffness measurement (LSM) and Baveno-VI criteria (B6C) are non-invasive tools for risk stratification.
- Hepatic venous pressure gradient (HVPG) is an invasive standard for assessing portal hypertension.
Purpose of the Study:
- To compare the utility of LSM alone and B6C versus HVPG in predicting clinical decompensation.
- To evaluate the feasibility of using LSM, B6C, and HVPG to guide beta-blocker initiation.
- To determine the optimal cut-off for LSM in predicting decompensation events.
Main Methods:
- Prospective follow-up of 626 compensated cirrhosis patients with baseline HVPG and LSM.
- Identification of optimal LSM cut-off for predicting decompensation.
- Comparison of LSM, HVPG (≥10 mmHg), and B6C performance using time-dependent AUC and positive/negative predictive values.
- Decision curve analysis (DCA) to assess the clinical utility of each strategy for beta-blocker initiation.
Main Results:
- A liver stiffness measurement (LSM) cut-off of 22 kPa demonstrated comparable negative predictive value and higher positive predictive value than HVPG and B6C for incident decompensations.
- LSM-based strategy identified more patients who would benefit from beta-blocker initiation compared to B6C and HVPG strategies.
- Decision curve analysis indicated LSM as a superior strategy for guiding beta-blocker therapy decisions.
Conclusions:
- Liver stiffness measurement (LSM) alone is a practical and effective alternative to Baveno-VI criteria (B6C) and hepatic venous pressure gradient (HVPG) for managing beta-blocker therapy in compensated cirrhosis.
- LSM-guided management can optimize the use of beta-blockers to prevent clinical decompensation.
- This non-invasive approach enhances risk stratification and treatment decisions in advanced liver disease.
Background And Aims:
Liver stiffness measurement (LSM) alone or its combination with platelet counts [Baveno-VI criteria (B6C)] is an important non-invasive tool to predict risk of clinical decompensation in patients with advanced compensated cirrhosis. We compared its utility to decide need for beta-blockers in this regard compared with hepatic venous pressure gradient (HVPG) estimation.
Methods:
Patients with compensated cirrhosis with available baseline HVPG and LSM were followed up over a median follow-up of 26 (IQR 7-55) months to determine onset of clinical decompensations. Optimal cut-off for LSM for predicting decompensations was identified and compared with HVPG of 10 mmHg and B6C. Feasibility of initiating beta-blockers based on these strategies was assessed using decision curve analysis (DCA) at different threshold probabilities of rates of clinical decompensation.
Results:
626 patients (mean age: 50.8 ± 12.4 years, 72.4% males) related to alcohol (30.3%), non-alcoholic steatohepatitis (26.4%), hepatitis C (16.6%), hepatitis B (10.2%) were included. Altogether, 132 (21.0%) patients developed clinical decompensation. The time-dependant area under curve over 5 years for HVPG and LSM for predicting clinical decompensation was 0.716-0.742 and 0.709-0.784, respectively. A LSM of 22 kPa (Sensitivity-88.6%/Specificity-51.8%) had a similar negative predictive value but a higher positive predictive value [37.9% (LSM) vs.30.9% (HVPG)vs.30.6% (B6C), p = 0.026 at 3 years] for incident decompensations. On DCA, LSM-based strategy emerged superior for deciding beta-blocker initiation with 150, 47, and 18 additional patients meriting treatment identified over and above B6C and HVPG based strategy at 5%, 10%, 20% annual rates of clinical decompensation, respectively.
Conclusion:
Measurement of liver stiffness alone can be a useful alternative to B6C and HVPG in deciding need for beta-blockers to prevent decompensations in compensated cirrhosis.
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