Blood‐ and Liver Stiffness‐Based Non‐Invasive Tests for Clinically Significant Portal Hypertension in Patients With cACLD and HCC

BACKGROUND AND AIMS: The applicability of non-invasive tests (NITs) for clinically significant portal hypertension (CSPH) in patients with hepatocellular carcinoma (HCC) is controversial. We performed a head-to-head comparison of various NITs for CSPH and evaluated rule-in/-out criteria. METHODS: We conducted a retrospective study including 283 patients with HCC undergoing hepatic venous pressure gradient (HVPG) measurement at the Vienna Hepatic Haemodynamic Lab with available, same-day data on NITs (i.e., liver stiffness measurement [LSM], platelet count [PLT], von Willebrand factor antigen [VWF:Ag], and the ratio of VWF:Ag and PLT [VITRO]). For the subsequent analysis, we focused on patients with compensated advanced chronic liver disease (cACLD). RESULTS: Among 164 patients with cACLD, most were BCLC 0/A (50.6%) and CSPH prevalence was 46.3%, the median LSM was 20.0 kPa (IQR: 13.3-37.9), and mean VWF:Ag/VITRO was 266 ± 119%/2.30 ± 1.81. The VITRO score yielded the highest discriminative ability to detect CSPH (AUROC: 0.834), followed by ANTICIPATE ± NASH (AUROC: 0.822), PLT (AUROC: 0.803), LSM (AUROC: 0.779), and VWF:Ag (AUROC: 0.707). The application of the Baveno VII criterium (LSM ≤ 15 kPa & PLT ≥ 150G/L) and the VITRO score (≤ 1.0) individually showed an excellent performance for ruling-out CSPH (sensitivities: ≥ 95%, NPV: 100%/87.9%). For ruling-in CSPH by individual criteria, the VITRO score provided the highest PPV (≥ 2.5, specificity/PPV: 89.8%/83.0%), followed by the Baveno VII criteria (specificity/PPV: 81.8%/74.6%). When sequentially applying Baveno VII criteria and VITRO, the grey zone could be significantly reduced to 16% (sensitivity/NPV: 94.7%/92.2%; specificity/PPV: 73.9%/84.4%). CONCLUSION: The discriminative ability in patients with cACLD and HCC was comparable to patients without HCC. However, PPVs of established criteria were < 90%, which may be explained by the comparatively low prevalence of CSPH in this context.