Shear wave elastography combined with ALBI score enhances prediction of hepatic decompensation in chronic liver...

Hepatic decompensation is a key determinant of prognosis in chronic liver disease (CLD). Shear wave elastography (SWE) is widely used to assess fibrosis, but its prognostic value for decompensation remains uncertain. We evaluated SWE alone and combined with the albumin-bilirubin (ALBI) score for risk prediction.

In this retrospective two-center cohort study, we analyzed 2,759 patients with CLD who underwent SWE between 2019 and 2025. The endpoint was time to first decompensation event. We evaluated the predictive performance of SWE, alone and with ALBI, in training (n = 1,839) and test (n = 920) sets.

During a median follow-up of 22.5 months, a total of 181 decompensation events and 53 deaths occurred. SWE alone demonstrated good performance for predicting decompensation (C-index 0.765) and overall survival. A 10 kPa threshold effectively stratified risk, with high-risk patients having higher hazards of decompensation and death (p <0.001). SWE and ALBI showed no statistical interaction, supporting their potential for complementary synergistic effects when combined. Integrating SWE with ALBI grade created a simple three-tier classification that further improved stratification, with high-risk patients (SWE >10 kPa and ALBI grade 2/3) having a 16.6-fold risk of decompensation and a 21.4-fold risk of death compared with low-risk patients (p <0.001). A Fine-Gray model in the training set generated a weighted linear formula (SWE + 18 × ALBI), termed the SALBI score, achieving the highest accuracy (C-index: training 0.804, test 0.820), outperforming SWE, ALBI, and MELD. The SALBI score stratified high-risk vs. low-risk groups, with 11.5-fold and 14.3-fold risks in train and test sets, respectively (p <0.001).

SWE is a robust prognostic marker for hepatic decompensation. A linear score combining SWE with ALBI further improves prediction and provides a practical tool for stratification.

Hepatic decompensation is a life-threatening event that defines prognosis in CLD. SWE provides a non-invasive assessment of liver stiffness, and its role in predicting decompensation has not been fully validated. In this large cohort of 2,759 patients, SWE was confirmed as a robust prognostic marker for decompensation. We further developed the SALBI score, a simple composite index combining SWE and ALBI, which significantly outperformed existing models. These findings highlight SWE and the SALBI score as practical tools for individualized risk stratification in CLD and support their potential incorporation into future clinical practice and guideline development.