Validation of Baveno VII Criteria using Liver and Splenic Elastography for Predicting Esophageal Varices Severity in Chronic Liver Disease: A Multiparametric, Observational Study

BACKGROUND AND AIMS: Baveno VII criteria prioritize Liver Stiffness Measurement (LSM) for portal hypertension risk stratification, primarily using transient elastography. We aimed to evaluate two-dimensional-shear wave elastography (2D-SWE) cutoffs, assess the etiology-dependent utility of spleen stiffness (SSM), and introduce a novel Combined Hepato-splenic Stiffness Index (CHSSI). MATERIALS AND METHODS: This ambispective, observational study enrolled 100 chronic liver disease patients. Participants underwent 2D-SWE for LSM and SSM, alongside endoscopy as the reference standard. A novel multiparametric index, CHSSI, was formulated. Diagnostic accuracy for Varices Needing Treatment (VNT; Grade >= II) was assessed using area under the receiver operating characteristic (AUROC). RESULTS: The cohort was predominantly Alcohol-related Liver Disease (ALD, 49%) and Viral Hepatitis (30%). LSM independently predicted VNT (P < 0.001), with an optimal 2D-SWE cutoff of 19.2 kPa (sensitivity 90% and specificity 82%). SSM utility diverged by etiology: it correlated significantly with variceal grade in ALD (r = 0.549, P < 0.001) but poorly in viral cirrhosis (r = 0.174, P = 0.358). The novel CHSSI demonstrated excellent diagnostic performance (AUROC 0.892) for predicting VNT. CONCLUSIONS: Liver stiffness remains the most robust single-parameter surrogate for esophageal varices. However, in heterogeneous cohorts where splenic stiffness alone yields inconsistent results, novel composite indices such as CHSSI and Liver Size-stiffness Index offer superior discriminative ability. These findings support a refined noninvasive risk stratification strategy, potentially reducing unnecessary screening endoscopies.