- Design
- Development and external validation of a machine-learning diagnostic score
- Population
- 1435 patients with compensated advanced chronic liver disease and paired HVPG
- Primary outcome
- Accuracy for clinically significant portal hypertension
- Effect
- AUC 0.91; grey zone 12.3% vs 47.9% with Baveno VII
This study, published in July 2026, developed a score combining liver and spleen stiffness from any of three elastography techniques with clinical variables, to identify clinically significant portal hypertension in compensated advanced chronic liver disease. It used 1435 patients with paired hepatic venous pressure gradient measurement, with external validation in 342 patients from seven centres.
In external validation, the score had an area under the curve of 0.91. Rule-out and rule-in cut-offs gave a negative predictive value of 0.91 and positive predictive value of 0.96. Only 12.3% of patients fell in the indeterminate zone, against 47.9% with the Baveno VII criteria.
Identifying significant portal hypertension non-invasively decides who should start a non-selective beta-blocker. Pressure measurement is rarely available outside tertiary centres in India, so a tool that classifies most patients without it would be valuable. Prospective validation is still required.
- Measure spleen stiffness alongside liver stiffness where your equipment allows.
- Use Baveno VII criteria in routine practice until newer scores are validated prospectively.
- Consider non-selective beta-blockers when significant portal hypertension is likely.
- Refer indeterminate cases for specialist assessment.
Why it matters
Half of compensated patients are left unclassified by current rules, delaying beta-blocker decisions.
Don't overread it
Retrospective development and validation; not yet ready for routine use.
The statistics, in plain English
An AUC of 0.91 means strong discrimination. A grey zone is the share of patients a rule cannot classify; shrinking it from 48% to 12% means far fewer need invasive testing. The model has not yet been tested prospectively.
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