Splenic stiffness measurement to predict decompensation in compensated advanced chronic liver disease

Figure 1 Study flowchart. c-ACLD: Compensated advanced chronic liver disease; HCV: Hepatitis C virus; HBV: Hepatitis B virus; MASLD: Metabolic dysfunction-associated steatotic liver disease; ArLD: Alcohol related liver disease; ACLF: Acute on chronic liver failure; ALD: Alcohol related steatotic liver disease; SSM: Splenic stiffness measurement.

Figure 2 Receiver operating curve comparing the diagnostic utility of splenic stiffness with other parameters for predicting one-year decompensation. SIP: SSM-INR-Platelet ratio; SSM: Splenic stiffness measurement; FIB-4: Fibrosis-4 index; APRI: AST to Platelet ratio index; LSM: Liver stiffness measurement.

Figure 3 Kaplan-Meier survival graph comparing 1-year decompensation-free and overall survival with a splenic stiffness measurement cut-off > 57. 5 kPa. Censored observations are indicated by “+”. Log-rank test was used to compare survival distributions. A: Decompensation-free survival; B: Overall survival. SSM: Spleen stiffness measurement.

Figure 4 Receiving operating curve for splenic stiffness measurement > 57. 5 kPa for predicting decompensation in different etiology groups. A: Hepatitis B virus-related compensated advanced chronic liver diseases (c-ACLD); B: Alcohol-related liver disease-related c-ACLD; C: Metabolic dysfunction-associated steatotic liver disease-related c-ACLD; D: Hepatitis C virus-related c-ACLD. AUC: Area under the curve; LSM: Liver stiffness measurement; SSM: Splenic stiffness measurement; FIB-4: Fibrosis-4 index; APRI: AST to Platelet ratio index; CI: Confidence interval.

Figure 5 Graphical abstract showing the final results of our study (splenic stiffness measurement to predict decompensation in patients with compensated advanced chronic liver decease. ArLD: Alcohol related liver disease; MASLD: Metabolic dysfunction-associated steatotic liver disease; AVB: Acute variceal bleeding; HBV: Hepatitis B virus; HCV: Hepatitis C virus; HE: Hepatic encephalopathy; AUC: Area under the curve; SSM: Splenic stiffness measurement; LSM: Liver stiffness measurement; FIB-4: Fibrosis-4 index; APRI: AST to Platelet ratio index.