Noninvasive prediction of clinically significant portal hypertension in metabolic dysfunction-associated steatotic liver disease compared to other chronic liver diseases

Table 1 Overview of studies on tests and models for clinically significant portal hypertension in patients with compensated, advanced chronic liver disease due to metabolic dysfunction-associated steatotic liver disease

Ref.	Journal name	Sample size	Test or model	Implications	Limitations
Pons et al[7], 2021	American Journal of Gastroenterology	n = 836	HVPG	Among patients with VCTE LSM > 25 kPa, the positive predictive value of CSPH was only 62.8% for obese MASH compared to other etiologies	Invasive test
Campoverde Cueva et al[9], 2024	Revista Colombiana de Gastroenterologia	n = 209	Baveno VII criteria	The Baveno VII criteria was noted to have a sensitivity of 96.7% and a NPV of 76.9% although the sensitivity and NPV improved to 98.4% and 90.9% after excluding patients with MASLD, respectively	Single center, ross-sectional study
Vutien et al[10], 2024	Hepatology	n = 17076	Baveno VII criteria, “Rule-of-Five” categories	Each “Rule-of-Five” category was associated with an increased risk of mortality and decompensation. In a subgroup analysis for patients with MASLD with body mass index > 30 kg/m2, similar results were noted	Retrospective study, limited number of patients with MASLD
Abraldes et al[2], 2016	Hepatology	n = 518	LSM by TE. LSM by TE and platelet count. Liver stiffness-spleen size-platelet ratio. Platelet-spleen ratio. Endoscopy/HVPG	All NITs identified patients with high risk of CSPH and a low risk of VNT. No significant interactions were reported between the NITs and the etiology of cirrhosis in any of the models	Limited number of patients with MASLD
Augustin et al[6], 2017	Hepatology	n = 925	Expanded Baveno VI criteria	The Expanded-Baveno VI criteria reportedly spared more endoscopies with a minimal risk of missing VNT in patients with cACLD from various etiologies including non-alcoholic steatohepatitis	Relatively limited number of patients with MASLD
Rabiee et al[8], 2022	Hepatology Communications	n = 222	FIB4+	Externally validated the Anticipate and Anticipate-MASH models in a cohort of patients with compensated MASH cirrhosis. Described a novel model using the FIB-4 index plus serum albumin, termed FIB4+, to predict CSPH which can be used where TE is not readily available	Higher pretest probability of CSPH in one of the cohorts. Further validation in patients with MASH
Wong et al[11], 2022	Journal of Gastroenterology and Hepatology	n = 633	CHESS-ALARM score	CHESS-ALARM score had significantly higher accuracy than model for end-stage liver disease, ALBI, ALBI-FIB-4 and LSM > 25 kPa to predict liver decompensation at 5 years	Limited number of patients with MASLD
Vutien et al[12], 2022	American Journal of Gastroenterology	n = 5849	FIB-5 score	The FIB-4 score and LS from FibroScan were combined into a single score, the FIB-5, which demonstrated superior discrimination compared to LS or FIB-4 alone, for patients with cACLD at risk for complications of portal hypertension	Retrospective study. Data from Veteran Affairs population. Further validation in patients with MASH
Paternostro et al[13], 2024	Journal of Hepatology	n = 340	HVPG	HVPG had a high prognostic value in patients with cACLD and MASLD	Invasive test
Liguori et al[14], 2024	Liver International	n = 254	Serum-free light chains	Serum-free light chain was demonstrated to be a dependable biomarker for stratification of cACLD in patients with MASLD	Case-control study
Huang et al[15], 2025	Hepatology	n = 1231	LSM, T2DM, HbA1c	The presence of T2DM and mean HbA1c were independent predictors of the progression of LSM in biopsy-proven MASLD	Data may not be generalized to regions outside of the United States. Possible selection bias
Williams et al[16], 2024	Digestive Disease and Sciences	n = 154	Spleen stiffness measurement	SSM was noted to have a higher failure rate in individuals with lower fibrosis stage, higher body-mas index, and a larger waist circumference. SSM was useful for excluding esophageal varices and high-risk esophageal varices in the study	Small sample size
Calès et al[20], 2025	Journal of Hepatology	n = 1051	FIB-9, FIB-11, FIB-12	A new generation of NITs for liver fibrosis in patients with MASLD, including the FIB-9, FIB-11 and FIB-12, have been reported to have greater accuracy compared to recommended NITs	Complex formula. Potentially costly
Liguori et al[19], 2024	Digestive and Liver Disease	n = 289	ELF test	ELF has been demonstrated to perform as well as histology from a liver biopsy for the evaluation of fibrosis and prediction of clinical outcomes in patients with MASLD	Small sample size. Further validation in patients with MASH
Torres et al[17], 2023	Annals of Hepatology	n = 183 training cohort. n = 261 validation cohort	FIB-4, MASLD fibrosis score	The cut-off points chosen were 1505 (sensitivity 85%, specificity 86%) for FIB-4 and -0.835 (sensitivity 100%, specificity 70%) for MASLD fibrosis score, which demonstrated greater specificity compared to the cut-off points currently used	Subjective nature of the evaluation of alcohol consumption. Data may not be generalized to other settings. Single radiologist performed analysis
Mózes et al[18], 2022	Gut	n = 5735	FIB-4 plus LSM-VCTE	Algorithm combining FIB-4 and LSM-VCTE sequentially in patients with MASLD with lower cut-offs to exclude advanced fibrosis and a higher cut-off value to rule-in cirrhosis, which reduced the need for liver biopsies	Data may not be generalized to other regions. Large chronological period during which LSM-VCTE underwent significant changes

ALBI: Albumin-bilirubin; CACLD: Compensated advanced chronic liver disease; CSPH: Clinically significant portal hypertension; ELF: Enhanced liver fibrosis; FIB: Fibrosis; HbA1c: Hemoglobin A1c; HVPG: Hepatic venous pressure gradient; LSM: Liver stiffness measurement; MASLD: Metabolic dysfunction associated steatotic liver disease; MASH: Metabolic dysfunction-associated steatohepatitis; NITs: Noninvasive tests; NPV: Negative predictive value; SSM: Splenic stiffness measurement; TE: Transient elastography; T2DM: Type 2 diabetes mellitus; VCTE: Vibration controlled transient elastography; VNT: Varices needing treatment.