Validation of Baveno VII criteria and other non-invasive diagnostic algorithms for clinically significant portal hypertension in hepatitis delta

Background Limited data exists on the applicability of non-invasive tests (NIT) for clinically significant portal hypertension (CSPH) in chronic hepatitis delta (CHD).

Methods CHD patients with compensated advanced chronic liver disease (cACLD), defined by liver stiffness measurement (LSM)≥10 kPa or advanced fibrosis/cirrhosison histology, who underwent paired assessment of hepatic venous pressure gradient (HVPG) and NIT at Hannover Medical School or Medical University of Vienna between 2013 and 2023 were retrospectively included.

LSM, von Willebrand factor to platelet count ratio (VITRO), spleen stiffness measurement (SSM) were assessed, and combined linear CSPH risk models (ANTICIPATE, 3P/5P model) based on LSM and/or readily available laboratory biomarkers were assessed. The diagnostic accuracy of Baveno-VII criteria was investigated.

Results We included 51 CHD-cACLD patients with a CSPH prevalence of 62.7%. The presence of CSPH was associated with higher LSM (25.8 [17.2-31.0] vs. 14.0 [10.5-19.8] kPa; p<0.001), VITRO (n=31, 3.5 [2.7-4.5] vs. 1.3 [0.6-2.0]%/[G/L]; p<0.001), and SSM (n=20, 53.8 [41.7-75.5] vs. 24.0 [17.0-33.9] kPa; p<0.001). The AUROC for CSPH of linear risk models were excellent (ANTICIPATE: 0.885, 3P: 0.903, 5P: 0.912). The application of Baveno-VII criteria could rule out/rule in CSPH with 100% sensitivity and 84.2% specificity, respectively. The diagnostic 'grey zone' of Baveno-VII criteria was significantly diminished, whilst maintaining high accuracy, when applying the previously published Baveno-VII-VITRO or Baveno-VII-SSM algorithm.

Conclusions NIT for CSPH are useful and accurate in CHD-cACLD patients, and should be applied to identify patients at high risk for hepatic decompensation.

Publication History

Article published online:
23 January 2024