Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Aug 27, 2025; 17(8): 109796
Published online Aug 27, 2025. doi: 10.4254/wjh.v17.i8.109796
Assessment of liver stiffness measurement-related markers in predicting liver-related events in viral cirrhosis with clinically significant portal hypertension
Yan-Qiu Li, Yong-Qi Li, Jin-Ze Li, Bing-Bing Zhu, Yu Lu, Ying Feng, Xian-Bo Wang
Yan-Qiu Li, Yong-Qi Li, Bing-Bing Zhu, Yu Lu, Ying Feng, Xian-Bo Wang, Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
Jin-Ze Li, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100037, China
Co-first authors: Yan-Qiu Li and Yong-Qi Li.
Co-corresponding authors: Ying Feng and Xian-Bo Wang.
Author contributions: Wang XB, Feng Y designed the manuscript. Li YQ and Li YQ drafted the manuscript. Lu Y carefully reviewed the manuscript. Li JZ, and Zhu BB drew the figures. All authors approved the final version of the manuscript. Li YQ performed data analysis and wrote the first draft of the paper. Li YQ was responsible for patient screening, enrollment and clinical data entry and collation. Both authors have made crucial and indispensable contributions towards the completion of the project and thus qualified as the co-first authors of the paper. Both Wang XB and Feng Y have played important and indispensable roles in the study design, data interpretation and manuscript preparation as the co-corresponding authors. Wang XB conceptualized, designed, supervised the whole process of the project, and submitted the current version of the manuscript. Feng Y was responsible for conceptualization, data re-analysis and re-interpretation, figure plotting, and comprehensive literature search. Both Wang XB and Feng Y obtained financial support for this project, and their collaboration was crucial for the publication of this manuscript.
Supported by the High-Level Chinese Medicine Key Discipline Construction Project, No. zyyzdxk-2023005; Capital’s Funds for Health Improvement and Research, No. 2024-1-2173; National Natural Science Foundation of China, No. 82474419 and No. 82474426; Beijing Municipal Natural Science Foundation, No. 7232272; and Beijing Traditional Chinese Medicine Technology Development Fund Project, No. BJZYZD-2023-12.
Institutional review board statement: The study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of Beijing Ditan Hospital (DTEC-KY2024-069-01).
Informed consent statement: All subjects signed informed consent.
Conflict-of-interest statement: The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript.
Data sharing statement: Data from this study are available on request to the corresponding author.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xian-Bo Wang, PhD, Chief Physician, Professor, Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, No. 8 Jingshun East Street, Chaoyang District, Beijing 100015, China. wangxb@ccmu.edu.cn
Received: May 22, 2025
Revised: June 18, 2025
Accepted: July 18, 2025
Published online: August 27, 2025
Processing time: 98 Days and 0.2 Hours
Abstract
BACKGROUND

Clinically significant portal hypertension (CSPH) is a crucial prognostic determinant for liver-related events (LREs) in patients with compensated viral cirrhosis. Liver stiffness measurement (LSM)-related markers may help to predict the risk of LREs.

AIM

To evaluate the value of LSM and its composite biomarkers [LSM-platelet ratio (LPR), LSM-albumin ratio (LAR)] in predicting LREs.

METHODS

This study retrospectively enrolled compensated viral cirrhosis patients with CSPH. The Cox regression model was employed to examine the prediction of LSM, LPR, and LAR for LREs. The model performance was assessed through receiver operating characteristic, decision curve, and time-dependent area under the curve analysis. The Kaplan-Meier curve was used to evaluate the cumulative incidence of LREs, and further stratified analysis of different LREs was performed.

RESULTS

A total of 598 patients were included, and 319 patients (53.3%) developed LREs during follow-up. Multivariate proportional hazards modeling demonstrated that LSM, LPR, and LAR were independent predictors of LREs. LPR had better performance in predicting LREs than LAR and LSM (area under the curve = 0.780, 0.727, 0.683, respectively, all P < 0.05). The cumulative incidence of LREs in the high-risk group were significantly higher than that in the low-risk group (P < 0.001). Among the different LREs, LPR was superior to LSM and LAR in predicting liver decompensation, while the difference in predicting hepatocellular carcinoma and liver-related death was relatively small.

CONCLUSION

LPR is superior to LSM and LAR in predicting LREs in compensated viral cirrhosis patients with CSPH, especially in predicting liver decompensation.

Keywords: Liver stiffness measurement; Liver stiffness measurement-platelet ratio; Liver stiffness measurement-albumin ratio; Liver-related events; Clinically significant portal hypertension; Viral cirrhosis

Core Tip: This study systematically evaluated the predictive value of liver stiffness measurement (LSM)-related markers for the liver related events (LREs) in compensated viral cirrhosis patients with clinically significant portal hypertension. The results showed that LSM-platelet ratio (LPR) is superior to LSM and LSM-albumin ratio in predicting LREs, especially in predicting liver decompensation. LPR can be served as an important tool for identification and individualized management in clinics.