Simple blood tests to diagnose compensated advanced chronic liver disease and stratify the risk of clinically...

Area of Science:

• Hepatology
• Clinical Diagnostics
• Biomarker Discovery

Background:

• Compensated advanced chronic liver disease (cACLD) poses a risk for clinically significant portal hypertension (CSPH) and liver complications.
• Limited availability of liver stiffness measurements (LSM) hinders cACLD/CSPH identification in non-specialized settings.
• Development of accessible, blood-based markers is crucial for early risk stratification.

Purpose of the Study:

• To develop and validate a blood-based algorithm for identifying cACLD using Fibrosis-4 (FIB-4).
• To develop and validate a blood-based algorithm for identifying CSPH using the von Willebrand factor/platelet count ratio (VITRO).
• To assess the diagnostic performance of FIB-4 and VITRO compared to existing methods.

Main Methods:

• Retrospective analysis of patient cohorts undergoing LSM/FIB-4 and HVPG/VITRO measurements.
• Development of prediction models using FIB-4 for hepatic decompensation and VITRO for CSPH.
• External and internal validation of the developed algorithms and comparison with Baveno-VII criteria.

Main Results:

• FIB-4 demonstrated high accuracy (AUROC: 0.914) in predicting hepatic decompensation, identifying patients at significant risk.
• VITRO showed excellent diagnostic performance (AUROC: 0.889) for CSPH, comparable to LSM and the ANTICIPATE model.
• VITRO effectively ruled out (sensitivity: 100.0%) and ruled in (specificity: 92.4%) CSPH, performing similarly to Baveno-VII criteria.

Conclusions:

• Simple laboratory tests, FIB-4 and VITRO, can effectively detect cACLD and stratify CSPH risk in patients with liver disease.
• This blood-based approach is broadly applicable outside specialized clinics, potentially improving early detection and intervention.
• FIB-4 and VITRO offer a practical alternative for identifying at-risk patients, complementing existing diagnostic tools.