Future directions in noninvasive prediction of cirrhosis decompensation: An opinion review

Table 1 Comparative analysis of hepatic venous pressure gradient and non-invasive models in portal hypertension: Practical considerations for clinical deployment

Parameter	HVPG measurement	Noninvasive indicators
Invasiveness and safety	As an invasive vascular procedure, HVPG measurement is associated with inherent risks of complications (e.g., access site hematoma, infection, or, rarely, more serious events)	Inherently non-invasive, eliminating procedure-related risks. This profile results in superior patient compliance and excellent suitability for serial monitoring
Cost-effectiveness	The high per-procedure cost imposes a significant economic burden on healthcare systems and patients, particularly when repeated assessments for treatment monitoring are necessary	Substantially more cost-effective. The lower cost per examination alleviates the overall economic burden, making these modalities ideal for large-scale screening and long-term surveillance
Accessibility and infrastructure	Requires a specialized setting, including highly trained interventional radiologists/hepatologists and a dedicated catheterization laboratory. Its implementation in primary care or resource-limited settings is not feasible	High accessibility. Techniques such as vibration-controlled transient elastography (e.g., FibroScan) have a shorter learning curve, and with increasingly portable devices, can be widely deployed in outpatient and primary care settings
Standardization and reproducibility	The accuracy and reproducibility of HVPG measurement are highly operator-dependent. Key sources of variability include: Technique: Measurements obtained using balloon catheters (recommended) may differ from those obtained using straight catheters. Sedation: The use of procedural sedation can alter systemic hemodynamics and pressure readings. Protocol adherence: Poor adherence to the standard protocol – specifically, failing to perform the required three separate measurements – introduces avoidable error	Sources of variability are distinct and often more manageable. Liver stiffness measurement/spleen stiffness measurement: Influenced by operator experience and patient factors (e.g., obesity, ascites, active hepatic inflammation). Standardized operating protocols are widely established and easier to implement uniformly. Serum models: Variability primarily stems from inter-laboratory assay differences, which can be mitigated through standardized calibration. Overall, non-invasive methods are more amenable to standardization and are associated with lower inter-center variability compared to HVPG

HVPG: Hepatic venous pressure gradient.