Noninvasive risk assessment of hepatic decompensation in patients with hepatitis B virus‐related liver cirrhosis

Abstract

AbstractBackground and AimHepatic decompensation is a major complication of liver cirrhosis. We validated the predictive performance of the newly proposed CHESS‐ALARM model to predict hepatic decompensation in patients with hepatitis B virus (HBV)‐related cirrhosis and compared it with other transient elastography (TE)‐based models such as liver stiffness‐spleen size‐to‐platelet (LSPS), portal hypertension (PH), varices risk scores, albumin‐bilirubin (ALBI), and albumin‐bilirubin‐fibrosis‐4 (ALBI‐FIB‐4).MethodsFour hundred eighty‐two patients with HBV‐related liver cirrhosis between 2006 and 2014 were recruited. Liver cirrhosis was clinically or morphologically defined. The predictive performance of the models was assessed using a time‐dependent area under the curve (tAUC).ResultsDuring the study period, 48 patients (10.0%) developed hepatic decompensation (median 93 months). The 1‐year predictive performance of the LSPS model (tAUC = 0.8405) was higher than those of the PH model (tAUC = 0.8255), ALBI‐FIB‐4 (tAUC = 0.8168), ALBI (tAUC = 0.8153), CHESS‐ALARM (tAUC = 0.8090), and variceal risk score (tAUC = 0.7990). The 3‐year predictive performance of the LSPS model (tAUC = 0.8673) was higher than those of the PH risk score (tAUC = 0.8670), CHESS‐ALARM (tAUC = 0.8329), variceal risk score (tAUC = 0.8290), ALBI‐FIB‐4 (tAUC = 0.7730), and ALBI (tAUC = 0.7451). The 5‐year predictive performance of the PH risk score (tAUC = 0.8521) was higher than those of the LSPS (tAUC = 0.8465), varices risk score (tAUC = 0.8261), CHESS‐ALARM (tAUC = 0.7971), ALBI‐FIB‐4 (tAUC = 0.7743), and ALBI (tAUC = 0.7541). However, there was no significant difference in the predictive performance among all models at 1, 3, and 5 years (P > 0.05).ConclusionsThe CHESS‐ALARM score was able to reliably predict hepatic decompensation in patients with HBV‐related liver cirrhosis and showed similar performance to the LSPS, PH, varices risk scores, ALBI, and ALBI‐FIB‐4.