Sex Does Not Affect the Performance of Noninvasive Tests for Clinically Significant Portal Hypertension in...

Clinically significant portal hypertension (CSPH) denotes the hemodynamic threshold for hepatic decompensation in advanced chronic liver disease and is increasingly diagnosed by noninvasive tests (NITs). Although liver stiffness measurement by vibration-controlled transient elastography is affected by body composition, intriguingly, no data on sex differences of its diagnostic or prognostic performance are available. We aimed to address this knowledge gap.

A total of 420 stable outpatients who underwent hepatic venous pressure gradient measurement from 2007 to 2022 at the Vienna Hepatic Hemodynamic Lab were included. The sex-specific diagnostic performance of prevailing NITs was evaluated. Moreover, the sex-specific cumulative incidences of first hepatic decompensation were analyzed using competing risk models stratified by the Baveno VII criteria and the sequential Baveno VII-VITRO algorithm.

Two-hundred eighty-one (66.9%) patients were men, whereas 139 (33.1%) were women. Liver stiffness measurement performed better in male patients (area under the receiver operating characteristic curve [AUROC] = 0.845) than in female patients (AUROC = 0.811; P = 0.447), whereas for VITRO, the AUROC in female patients (0.854) was higher, as compared with male (0.814) subjects ( P = 0.370). The ANTICIPATE ± metabolic dysfunction-associated steatohepatitis model exhibited the highest AUROC in both sexes (male = 0.885; female = 0.872; P = 0.755). Finally, Baveno VII criteria and the sequential Baveno VII-VITRO algorithms were similarly effective in ruling-in/out CSPH in men and women. Thus, we observed a comparable diagnostic performance of NITs between the sexes, with no statistically significant differences. Interestingly, female patients classified as ruled-in by Baveno VII as well as by sequential Baveno VII-VITRO algorithm showed a trend toward higher decompensation rates, as compared with males.

Individual NITs and Baveno VII-based algorithms show a similar accuracy for the diagnosis of CSPH and prognostication in men and women.