Relative change rate of liver stiffness measurements predicts the risk of liver decompensation in compensated advanced chronic liver disease

Abstract

Patients with compensated advanced chronic liver disease (cACLD) have a significant risk of decompensation. Therefore, this study aimed to evaluate the predictive value of dynamic liver stiffness measurements (LSM) for decompensation risk, and their performance across different clinically significant portal hypertension (CSPH) risk stratification. This retrospective cohort study included 1409 patients with cACLD. Patients were divided into no CSPH, probable CSPH, and certain CSPH groups. Competing risk regression analysis was used to identify the independent predictors. The receiver operating characteristic curve and time-dependent area under the curve were used to evaluate the predictive performance. During follow-up, liver decompensation incidence increased with CSPH severity (22.2% with no CSPH, 37.5% with probable CSPH, and 64.9% with certain CSPH, p < 0.001). Multivariate regression analysis identified age, basal LSM1, delta LSM/LSM1, delta LSM/delta year, spleen diameter, and international normalized ratio as independent risk factors for liver decompensation. In the no CSPH group, spleen diameter showed the best predictive ability (AUC = 0.710). For probable and certain CSPH groups, delta LSM/LSM1 showed superior predictive performance (AUC: 0.777 and 0.782, respectively). The predictive power of basal LSM1 was relatively limited across all groups (AUC: 0.554-0.639). Subgroup analysis revealed interactions between age, sex, different etiologies, and CSPH subgroups. The relative change rate of LSM outperformed basal LSM1 and annual change rate in predicting liver decompensation risk, particularly in patients with existing portal hypertension. Dynamic assessments and differentiated prediction strategies are essential for optimal patient managements.

Keywords: Clinically significant portal hypertension; Compensated advanced chronic liver disease; Dynamic changes; Liver decompensation; Liver stiffness measurement.

Fig. 1

Dynamic changes in LSM and their relationship with liver decompensation. (a) Distribution of dynamic LSM changes in patients with cACLD. (b) Sankey diagram showing the relationship between baseline CSPH status, LSM dynamic changes, and decompensation outcomes. cACLD, compensated advanced chronic liver disease; CSPH, clinically significant portal hypertension; LSM, liver stiffness measurements

Fig. 2

Cumulative incidence of liver decompensation based on CSPH status and LSM dynamic changes. a Cumulative incidence of liver decompensation in cALCD stratified by CSPH status. b Cumulative incidence of liver decompensation in cALCD stratified by LSM dynamic changes. c Cumulative incidence of liver decompensation in patients without CSPH stratified by LSM dynamic changes. d Cumulative incidence of liver decompensation in patients with probable CSPH stratified by LSM dynamic changes. e Cumulative incidence of liver decompensation in patients with certain CSPH stratified by LSM dynamic changes. cACLD, compensated advanced chronic liver disease; CSPH, clinically significant portal hypertension; LSM, liver stiffness measurements

Fig. 3

Prediction value of different predictors for liver decompensation in cACLD patients stratified by CSPH status. ROC curves (a) and time-dependent AUC curves (b) showing the predictive performance of LSM1, delta LSM/LSM1, delta LSM/delta year, spleen diameter, and INR for liver decompensation in patients without CSPH. ROC curves (c) and time-dependent AUC curves (d) for patients with probable CSPH. ROC curves (e) and time-dependent AUC curves (f) in patients with certain CSPH. cACLD, compensated advanced chronic liver disease; CSPH, clinically significant portal hypertension; LSM, liver stiffness measurement; LSM1, basal LSM; INR, international normalized ratio; ROC, receiver operating characteristic curve; AUC, area under the curve

Fig. 4

Subgroup analyses of the predictive value of basal and dynamic LSM indices for liver decompensation in cACLD patients. Forest plot showing the association between basal LSM1 (a), delta LSM/LSM1 (b), delta LSM/delta year (c) and risk of liver decompensation in different subgroups. N, number of patients in each subgroup; P value, statistical significance for each subgroup association; P for interaction, P-value testing for interaction between the LSM parameter and subgroup variable. cACLD, compensated advanced chronic liver disease; CSPH, clinically significant portal hypertension; LSM, liver stiffness measurement; LSM1, basal LSM; SHR, subdistribution hazard ratio; CI, confidence interval