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Publications

Journal Article Ahead of print

PubMed: 42276315 DOI: 10.1016/j.cgh.2026.05.033

Hepatic venous pressure gradient, non-invasive tests, and prognosis across the subtypes of advanced steatotic liver disease.

Clin Gastroenterol Hepatol

Authors: Benedikt S Hofer, Sarah Shalaby, Wilhelmus Kwanten, Dario Saltini, Luis Téllez, José Luis Calleja, Federico Caceres, Angela Puente, Alba Jiménez-Masip, Lucile Moga, Daniel Gutmann, Grazia Pennisi, Petra Fischer, Raluca Pais, Dominik Bettinger, Lisa Sandmann, Alba Ardevol, Christian Sebesta, Isabel Graupera, Lotte Schoenmakers, Thomas Vanwolleghem, Esther Maderuelo, Anna Brujats, Angela Anton, Juan M Pericàs, Helena Masnou, Benjamin Maasoumy, Vlad Ratziu, Bogdan Procopet, Salvatore Petta, Emmanuel A Tsochatzis, Pierre-Emmanuel Rautou, Joan Genescà, Jose Ignacio Fortea, Edilmar Alvarado-Tapias, Elba Llop, Agustín Albillos, Filippo Schepis, Michael Trauner, Mattias Mandorfer, Thomas Reiberger, Sven Francque, Virginia Hernandez-Gea, Georg Semmler

Affiliations

  • Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria.
  • Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Fundació de Recerca Clínic Barcelona (FRCB-IDIABPS). Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-RareLiver). Centro de referencia del Sistema nacional de salud en enfermedad hepática compleja (CSUR), Barcelona, Spain. Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain. Universitat de Barcelona, Barcelona, Spain.
  • Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium. Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-RARE-LIVER); Laboratory of Experimental Medicine and Paediatrics (LEMP) - Gastroenterology & Hepatology, University of Antwerp, Antwerp, Belgium.
  • Severe Liver Diseases (M.E.C.) Departmental Unit, Department of Medical Specialties, University Hospital of Modena "Policlinico", University of Modena and Reggio Emilia, Modena, Italy.
  • Department of Gastroenterology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Universidad de Alcalá, CIBEREHD, ISCIII, Madrid, Spain.
  • Servicio de Gastroenterología y Hepatología. Hospital Universitario Puerta de Hierro Majadahonda. IDIPHISA. Universidad Autònoma de Madrid, CIBERehd, Madrid, Spain.
  • Division of Gastroenterology and Hepatology, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Sant Pau (IR SANT PAU), Universitat Autònoma de Barcelona, Barcelona, Spain.
  • Gastroenterology and Hepatology Department, University Hospital Marqués de Valdecilla, Health Research Institute Marqués de Valdecilla (IDIVAL), Santander, Spain.
  • Liver Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut of Research (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra, Spain; CIBEREHD, ISCIII, Madrid, Spain.
  • Service d'Hépatologie, AP-HP, Hôpital Beaujon, DMU DIGEST, Centre de Référence des Maladies Vasculaires du Foie, FILFOIE, Clichy, France.
  • Department of Hepatology and Liver Transplantation, Royal Free London NHS Foundation Trust, London, United Kingdom.
  • Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine, and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy.
  • Regional Institute of Gastroenterology and Hepatology "Octavian fodor", Hepatology Department and "luliu Hatieganu" University of Medicine and Pharmacy, 3(rd) Medical Clinic, Cluj-Napoca, Romania.
  • Sorbonne Université, ICAN Institute for Metabolism and Nutrition, Hospital Pitié-Salpêtrière, Paris, France.
  • University Medical Center Freiburg, Department of Medicine II, Germany.
  • Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany.
  • Hospital Universitari Germans Trias I Pujol, Universitat Autònoma de Barcelona, Badalona, Spain.
  • Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria.
  • Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Fundació de Recerca Clínic Barcelona (FRCB-IDIABPS). Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-RareLiver). Centro de referencia del Sistema nacional de salud en enfermedad hepática compleja (CSUR), Barcelona, Spain. Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain. Universitat de Barcelona, Barcelona, Spain.
  • Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium. Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-RARE-LIVER); Laboratory of Experimental Medicine and Paediatrics (LEMP) - Gastroenterology & Hepatology, University of Antwerp, Antwerp, Belgium.
  • Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium. Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-RARE-LIVER); Laboratory of Experimental Medicine and Paediatrics (LEMP) - Gastroenterology & Hepatology, University of Antwerp, Antwerp, Belgium.
  • Servicio de Gastroenterología y Hepatología. Hospital Universitario Puerta de Hierro Majadahonda. IDIPHISA. Universidad Autònoma de Madrid, CIBERehd, Madrid, Spain.
  • Division of Gastroenterology and Hepatology, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Sant Pau (IR SANT PAU), Universitat Autònoma de Barcelona, Barcelona, Spain; Centre for Biomedical Research in Liver and Digestive Diseases Network (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.
  • Division of Gastroenterology and Hepatology, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Sant Pau (IR SANT PAU), Universitat Autònoma de Barcelona, Barcelona, Spain.
  • Liver Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut of Research (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra, Spain; CIBEREHD, ISCIII, Madrid, Spain.
  • Hospital Universitari Germans Trias I Pujol, Universitat Autònoma de Barcelona, Badalona, Spain.
  • Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany.
  • Sorbonne Université, ICAN Institute for Metabolism and Nutrition, Hospital Pitié-Salpêtrière, Paris, France.
  • Regional Institute of Gastroenterology and Hepatology "Octavian fodor", Hepatology Department and "luliu Hatieganu" University of Medicine and Pharmacy, 3(rd) Medical Clinic, Cluj-Napoca, Romania.
  • Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine, and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy.
  • Department of Hepatology and Liver Transplantation, Royal Free London NHS Foundation Trust, London, United Kingdom.
  • Service d'Hépatologie, AP-HP, Hôpital Beaujon, DMU DIGEST, Centre de Référence des Maladies Vasculaires du Foie, FILFOIE, Clichy, France.
  • Liver Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut of Research (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra, Spain; CIBEREHD, ISCIII, Madrid, Spain.
  • Gastroenterology and Hepatology Department, University Hospital Marqués de Valdecilla, Health Research Institute Marqués de Valdecilla (IDIVAL), Santander, Spain.
  • Division of Gastroenterology and Hepatology, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Sant Pau (IR SANT PAU), Universitat Autònoma de Barcelona, Barcelona, Spain; Centre for Biomedical Research in Liver and Digestive Diseases Network (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.
  • Servicio de Gastroenterología y Hepatología. Hospital Universitario Puerta de Hierro Majadahonda. IDIPHISA. Universidad Autònoma de Madrid, CIBERehd, Madrid, Spain.
  • Department of Gastroenterology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Universidad de Alcalá, CIBEREHD, ISCIII, Madrid, Spain.
  • Severe Liver Diseases (M.E.C.) Departmental Unit, Department of Medical Specialties, University Hospital of Modena "Policlinico", University of Modena and Reggio Emilia, Modena, Italy.
  • Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria.
  • Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria.
  • Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria.
  • Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium. Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-RARE-LIVER); Laboratory of Experimental Medicine and Paediatrics (LEMP) - Gastroenterology & Hepatology, University of Antwerp, Antwerp, Belgium.
  • Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Fundació de Recerca Clínic Barcelona (FRCB-IDIABPS). Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-RareLiver). Centro de referencia del Sistema nacional de salud en enfermedad hepática compleja (CSUR), Barcelona, Spain. Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain. Universitat de Barcelona, Barcelona, Spain.
  • Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria.

Abstract

BACKGROUND & AIMS

Steatotic liver disease (SLD) encompasses metabolic dysfunction-associated liver disease (MASLD), alcohol-related liver disease (ALD), and a mixed type (MetALD). We investigated the course of compensated advanced chronic liver disease (cACLD) across SLD subtypes, the impact of clinically significant portal hypertension (CSPH), and the role of non-invasive tests (NITs).

METHODS

This study included SLD patients with cACLD from 17 centers undergoing hepatic venous pressure gradient (HVPG) and NIT assessment through December 2023. Primary outcomes were first hepatic decompensation and liver-related mortality.

RESULTS

Among 696 patients (ALD 22%, MetALD 20%, MASLD 58%), 94% had Child-Pugh A, and 60% had CSPH. Over a median follow-up of 3.8 years, 170 patients decompensated and 137 died (58% liver-related). The three-year cumulative decompensation incidence was highest in ALD (26%), followed by MetALD (21%) and MASLD (15%), yet differences were no longer significant after adjusting for age, sex, MELD, albumin, and HVPG. Similarly, liver-related mortality did not differ by SLD subtype in adjusted models. CSPH independently predicted decompensation across all subtypes. The ANTICIPATE-NASH model showed high and comparable diagnostic accuracy for CSPH across ALD, MetALD, and MASLD (AUROC 0.831-0.894). An ANTICIPATE-NASH probability ≥60% for ruling-in CSPH outperformed the original ANTICIPATE model in all subtypes and independently predicted decompensation with similar effect sizes (aSHR 2.57-2.71).

CONCLUSIONS

Higher crude decompensation rates in ALD and MetALD reflect more severe liver disease at presentation, yet outcomes are comparable across the SLD spectrum after accounting for disease severity. ANTICIPATE-NASH accurately identifies CSPH across SLD subtypes, and both invasive and non-invasive measures of portal hypertension predict decompensation and liver-related death.

MeSH

Liver Diseases, Hypertension, Mortality, Non-Alcoholic Fatty Liver Disease, Venous Pressure, Liver, Hypertension, Portal, Prognosis