Related Experiment Video
Updated: Sep 22, 2025
A Three-Dimensional Spheroid Model to Investigate the Tumor-Stromal Interaction in Hepatocellular Carcinoma
Published on: September 30, 2021
ABC: a novel algorithm to stratify decompensation risk in patients with compensated advanced chronic liver disease
Chuan Liu1, Jia Li2, Yu Jun Wong3,4
1Department of Radiology, Center of Portal Hypertension, Zhongda Hospital, Medical School, Southeast University, Nanjing, 210009, China.
Insights
The novel ABC model effectively stratifies decompensation risk in compensated advanced chronic liver disease (cACLD) patients. This tool can help determine the need for hepatic venous pressure gradient (HVPG) evaluation, potentially reducing unnecessary procedures.
Area of Science:
- Hepatology
- Clinical Risk Stratification
- Liver Disease Management
Background:
- Compensated advanced chronic liver disease (cACLD) requires accurate risk stratification to prevent liver-related mortality.
- Clinical decompensation is a critical precursor to liver-related death, highlighting the need for precise risk assessment in cACLD.
Purpose of the Study:
- To develop and validate a novel risk stratification model for decompensation in cACLD.
- To assess the utility of the new model in guiding decisions regarding hepatic venous pressure gradient (HVPG) evaluation and management.
Main Methods:
- A multicenter international study involving three cohorts (training, validation, HVPG) from 2009 to 2021.
- Development of the CHESS criteria and the Algorithm based on Baveno VI criteria plus CHESS criteria (ABC model) in the training cohort.
- Validation of the ABC model in an independent cohort and its application in diagnosing clinically significant portal hypertension (CSPH) in the HVPG cohort.
Main Results:
- The ABC model incorporates liver stiffness measurement (LSM), platelet count (PLT), albumin, alanine aminotransferase (ALT), and varices to predict decompensation risk.
- The model demonstrated strong predictive performance with a 3-year time-dependent area under the curve (tAUC) of 0.851 in the training cohort and 0.843 in the validation cohort.
- In the HVPG cohort, the high-risk group identified by the ABC model showed a 93.0% positive predictive value for CSPH, enabling targeted HVPG evaluation.
Conclusions:
- The ABC model provides effective risk stratification for decompensation in cACLD patients.
- HVPG evaluation can be potentially waived for low-risk and high-risk cACLD patients, who can be managed based on Baveno VI criteria or non-selective β-blockers, respectively.
- Medium-risk cACLD patients identified by the ABC model warrant further HVPG evaluation for precise management decisions.
Background:
Liver-related death is preceded by clinical decompensation; therefore, the risk stratification of decompensation in compensated advanced chronic liver disease (cACLD) is extraordinary significant.
Methods:
The international, multicenter study included three cohorts from January 2009 to August 2021. In training cohort, the unfavorable Baveno VI criteria patients were used to develop the novel CHESS criteria to stratify decompensation risk. The Algorithm based on Baveno VI criteria plus CHESS criteria (ABC model) was validated in validation cohort, and used to diagnose clinically significant portal hypertension (CSPH) in hepatic venous pressure gradient (HVPG)-performed cohort.
Results:
A total of 1377 cACLD patients were enrolled. In training cohort, multivariate analysis revealed that liver stiffness measurement (LSM), platelet count (PLT), albumin, alanine aminotransferase (ALT) and varices were the independent risk factors for hepatic decompensation. The novel CHESS criteria was produced (0.036 × LSM [kPa]) + (- 0.013 × PLT [109/L]) + (- 0.068 × Albumin [g/L])) + (- 0.016 × ALT [U/L]) + (0.651 × Varices [present: 1, absent: 0]), and < - 4.4, - 4.4 to - 3.1 and > - 3.1 indicated the low risk, medium risk, and high risk of decompensation, with a 3 year-time-dependent area under the curve (tAUC) of 0.851 (0.800-0.901). In validation cohort, the 3 year-tAUC of ABC model was 0.843 (0.742-0.943). Notably, in HVPG cohort, the high risk group was used to rule in CSPH with a positive predictive value of 93.0%.
Conclusions:
The ABC model can stratify the risk of decompensation in cACLD. HVPG evaluation can be waived in both low risk and high risk cACLD patients as they can be managed by Baveno VI criteria and non-selective β-blockers intervention, respectively, and the remaining medium risk patients need further HVPG evaluation.
Related Concept Videos
01:29Chronic Pancreatitis II: Collaborative Care
Assessment:
01:30Heart Failure IV: Classification and Diagnostic Evaluation