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

Abstract

Hepatic 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). Four 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). During the study period, 48 patients (10.0%) developed hepatic decompensation (median 93months). 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 5years (P>0.05). The 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.