Assessment of liver stiffness measurement-related markers in predicting liver-related events in viral cirrhosis with clinically significant portal hypertension

doi:10.4254/wjh.v17.i8.109796

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World Journal of Hepatology

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1948-5182

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World J Hepatol. Aug 27, 2025; 17(8): 109796
Published online Aug 27, 2025. doi: 10.4254/wjh.v17.i8.109796

Table 1 Baseline characteristics of compensated viral cirrhosis patients with clinically significant portal hypertension, n (%)

	Overall cohort (n = 598)	Training cohort (n = 419)	Validation cohort (n = 179)	P value
Age, years	54 (51-58)	54 (51-58)	53 (51-58.5)	0.498
Sex, male/female (%male)	400 (66.9)	275 (65.6)	125 (69.8)	0.318
LREs	319 (53.3)	222 (53.0)	97 (54.2)	0.786
Decompensation	284 (46.5)	199 (47.5)	85 (47.5)
HCC	26 (4.3)	17 (4.1)	9 (5.0)
Liver-related death	9 (1.5)	6 (1.4)	3 (1.7)
Follow-up time, months	37 (21, 55)	37 (20.5, 56)	37 (22, 53.5)	0.913
Spleen diameter, cm	14.4 (12.7-16)	14.4 (12.7-16.1)	14.4 (12.8-16)	0.638
AST, U/L	33.5 (25.8-48.3)	34 (26.1-47.6)	32.5 (25.5-48.5)	0.402
ALT, U/L	27.1 (19.3-40)	27.6 (19.6-40.6)	26.2 (18.5-39.3)	0.434
TB, μmol/L	19.4 (14.4-28.9)	19.4 (14-29)	20.7 (14.9-28.7)	0.645
ALB, g/L	40.4 (35.7-45)	40.8 (36.1-45.3)	39.1 (35.1-44.3)	0.141
INR	1.17 (1.09-1.23)	1.17 (1.08-1.21)	1.18 (1.09-1.26)	0.196
NLR	1.91 (1.39-2.68)	1.89 (1.365-2.72)	1.95 (1.45-2.66)	0.683
Hb, g/L	138 (122-150)	137 (121-149.5)	140 (124-151)	0.101
PLT, 10⁹/L	78 (55-106)	76 (53.5-107.5)	82.4 (59-104)	0.240
LSM, kPa	26.6 (21.1-37.4)	26.3 (21.1-35.8)	27.4 (21.3-40.3)	0.246
LPR	0.37 (0.23-0.57)	0.37 (0.23-0.58)	0.35 (0.24-0.55)	0.830
LAR	0.68 (0.50, 1.02)	0.68 (0.5, 1.00)	0.68 (0.50, 1.05)	0.535

Medians (IQR) or counts (proportions). LREs: Liver related events; HCC: Hepatocellular carcinoma; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; TB: Total bilirubin; ALB: Albumin; INR: International normalized ratio; NLR: Neutrophil-to-lymphocyte ratio; Hb: Hemoglobin; PLT: Platelets; LSM: Liver stiffness measurement; LPR: Liver stiffness measurement-platelet ratio; LAR: Liver stiffness measurement-albumin ratio.

Table 2 Risk factors for liver related events in compensated viral cirrhosis patients with clinically significant portal hypertension

	Univariate analysis		Multivariate analysis of LSM model		Multivariate analysis of LPR model		Multivariate analysis of LAR model
	HR (95%CI)	P value	aHR (95%CI)	P value	aHR (95%CI)	P value	aHR (95%CI)	P value
LSM	1.03 (1.02-1.04)	< 0.001	1.03 (1.02-1.04)	< 0.001
LPR	2.79 (2.10-3.69)	< 0.001			2.30 (1.55-3.42)	< 0.001
LAR	2.32 (1.79-3.00)	< 0.001					2.37 (1.66-3.38)	< 0.001
Age	1.01 (1.00-1.03)	0.146
Gender	0.88 (0.67-1.15)	0.337
Spleen diameter	1.06 (1.01-1.11)	0.020	0.99 (0.93-1.04)	0.600	0.99 (0.93-1.03)	0.436	0.99 (0.94-1.05)	0.677
AST	1.00 (1.00-1.01)	0.330
ALT	1.00 (1.00-1.00)	0.388
TB	1.01 (1.01-1.02)	0.002	1.00 (1.00-1.01)	0.821	1.00 (0.99-1.01)	0.813	1.00 (0.99-1.01)	0.501
ALB	0.96 (0.94-0.97)	< 0.001	0.99 (0.96-1.02)	0.552	0.99 (0.96-1.01)	0.337	1.01 (0.98-1.04)	0.490
INR	5.18 (1.98-13.54)	0.004	1.96 (0.73-5.28)	0.183	2.48 (0.94-6.54)	0.066	2.43 (0.91-6.46)	0.076
NLR	1.12 (1.04-1.20)	0.002	1.09 (1.01-1.18)	0.029	1.09 (1.01-1.18)	0.022	1.10 (1.02-1.18)	0.018
Hb	0.99 (0.98-0.99)	< 0.001	0.99 (0.99-1.01)	0.083	1.00 (0.99-1.00)	0.167	0.99 (0.99-1.00)	0.143
PLT	0.99 (0.99-1.00)	< 0.001	0.99 (0.99-1.00)	< 0.001	1.00 (0.99-1.00)	0.556	0.99 (0.99-1.00)	0.001

HR: Hazard ratios; aHR: Adjusted hazard ratios; LSM: Liver stiffness measurement; LPR: LSM-platelet ratio; LAR: LSM-albumin ratio; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; TB: Total bilirubin; ALB: Albumin; INR: International normalized ratio; NLR: Neutrophil-to-lymphocyte ratio; Hb: Hemoglobin; PLT: Platelets.

Table 3 Prognostic performance of liver stiffness measurement and its composite markers for liver related events

Cohort	AUROC (95%CI)	Sensitivity	Specificity	PPV	NPV	C-index (95%CI)
Training cohort
LSM	0.683 (0.632-0.733)	0.57	0.73	0.65	0.66	0.683 (0.631-0.734)
LPR	0.780 (0.736-0.824)	0.7	0.73	0.69	0.73	0.780 (0.736-0.825)
LAR	0.727 (0.679-0.775)	0.57	0.8	0.71	0.68	0.727 (0.678-0.776)
Validation cohort
LSM	0.661 (0.581-0.740)	0.56	0.7	0.61	0.65	0.661 (0.580-0.742)
LPR	0.753 (0.682-0.824)	0.62	0.8	0.73	0.72	0.753 (0.681-0.825)
LAR	0.686 (0.608-0.765)	0.76	0.6	0.61	0.74	0.686 (0.607-0.766)

LSM: Liver stiffness measurement; LPR: Liver stiffness measurement-platelet ratio; LAR: Liver stiffness measurement-albumin ratio; AUROC: Area under the receiver operating characteristic; PPV: Positive predictive value; NPV: Negative predictive value.

Table 4 Cumulative incidence of liver-related events according to liver stiffness measurement and its composite indicators

Cohort	1-year cumulative incidence (%)	3-year cumulative incidence (%)	5-year cumulative incidence (%)
Training cohort
LSM ≥ 25.25	3.3 (1.0-5.5)	38.9 (32.4-45.5)	71.7 (64.8-78.6)
< 25.25	2.4 (0.1-4.6)	13.2 (7.6-18.8)	44.6 (34.4-54.8)
LPR ≥ 0.35	3.2 (0.9-5.5)	39.7 (32.9-46.5)	77.3 (70.8-83.8)
< 0.35	1.5 (0.2-3.3)	14.8 (9.2-20.3)	38.4 (28.7-48.1)
LAR ≥ 0.80	3.1 (1.0-5.2)	37.5 (31.3-43.8)	73.1 (66.7-79.6)
< 0.80	2.6 (0.1-5.1)	12.4 (6.6-18.1)	37.4 (26.5-48.2)
Validation cohort
LSM ≥ 24.15	1.8 (0.7-4.4)	31.9 (22.7-41.1)	77.2 (67.4-86.9)
< 24.15	2.9 (1.1-7.0)	23.5 (12.0-34.9)	54.1 (37.3-71.0)
LPR ≥ 0.35	3.1 (0.0-6.6)	34.1 (24.1-44.1)	78.2 (68.4-87.9)
< 0.35	1.2 (0.0-3.6)	24.1 (13.6-34.7)	51.5 (36.7-66.2)
LAR ≥ 0.80	1.7 (0.0-4.1)	31.1 (22.2-40.0)	74.4 (64.8-84.1)
< 0.80	3.3 (0.0-7.7)	24.3 (12.0-36.6)	59.6 (40.0-79.1)

LSM: Liver stiffness measurement; LPR: Liver stiffness measurement-platelet ratio; LAR: Liver stiffness measurement-albumin ratio.

Citation: Li YQ, Li YQ, Li JZ, Zhu BB, Lu Y, Feng Y, Wang XB. Assessment of liver stiffness measurement-related markers in predicting liver-related events in viral cirrhosis with clinically significant portal hypertension. World J Hepatol 2025; 17(8): 109796
URL: https://www.wjgnet.com/1948-5182/full/v17/i8/109796.htm
DOI: https://dx.doi.org/10.4254/wjh.v17.i8.109796