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Peer-reviewedCC BY-NC 4.0Liver International

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

  • Lorenz Balcar1,2,3
  • Tina Jasmin Haunold1,2,3
  • Mathias Jachs1,2,3
  • Georg Semmler1,2,3
  • Benedikt Simbrunner1,2,3
  • Albert Friedrich Stättermayer1,2,3
  • David Pereyra4,5
  • Christoph Schwarz4
  • Stefan Stremitzer4
  • Klaus Kaczirek4
  • Patrick Starlinger5
  • Peter Quehenberger6
5 more authors
  • Michael Trauner1,3
  • Bernhard Scheiner1,2,3
  • Thomas Reiberger1,2,3
  • Matthias Pinter1
  • Mattias Mandorfer1,2,3
6 affiliations
  1. 1Division of Gastroenterology and Hepatology, Department of Medicine III Medical University of Vienna Vienna Austria
  2. 2Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Medicine III Medical University of Vienna Vienna Austria
  3. 3Clinical Research Group MOTION Medical University of Vienna Vienna Austria
  4. 4Department of General Surgery Medical University of Vienna Vienna Austria
  5. 5Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery Mayo Clinic Rochester Minnesota USA
  6. 6Department of Laboratory Medicine Medical University of Vienna Vienna Austria
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Abstract

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.

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Cite

BibTeXRIS
BibTeX
@article{balcar2026blood,
  title = {{Blood‐ and Liver Stiffness‐Based Non‐Invasive Tests for Clinically Significant Portal Hypertension in Patients With cACLD and HCC}},
  author = {Lorenz Balcar and Tina Jasmin Haunold and Mathias Jachs and Georg Semmler and Benedikt Simbrunner and Albert Friedrich Stättermayer and David Pereyra and Christoph Schwarz and Stefan Stremitzer and Klaus Kaczirek and Patrick Starlinger and Peter Quehenberger and Michael Trauner and Bernhard Scheiner and Thomas Reiberger and Matthias Pinter and Mattias Mandorfer},
  journal = {Liver International},
  year = {2026},
  month = oct,
  doi = {10.1111/liv.70947},
  url = {https://doi.org/10.1111/liv.70947},
  note = {CC BY-NC 4.0},
}
RIS
TY  - JOUR
TI  - Blood‐ and Liver Stiffness‐Based Non‐Invasive Tests for Clinically Significant Portal Hypertension in Patients With cACLD and HCC
AU  - Lorenz Balcar
AU  - Tina Jasmin Haunold
AU  - Mathias Jachs
AU  - Georg Semmler
AU  - Benedikt Simbrunner
AU  - Albert Friedrich Stättermayer
AU  - David Pereyra
AU  - Christoph Schwarz
AU  - Stefan Stremitzer
AU  - Klaus Kaczirek
AU  - Patrick Starlinger
AU  - Peter Quehenberger
AU  - Michael Trauner
AU  - Bernhard Scheiner
AU  - Thomas Reiberger
AU  - Matthias Pinter
AU  - Mattias Mandorfer
PY  - 2026
DA  - 2026/10/26
JO  - Liver International
DO  - 10.1111/liv.70947
UR  - https://doi.org/10.1111/liv.70947
AB  - 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.
SN  - 1478-3223
SN  - 1478-3231
ER  -