Evidence map›Paper›PMID 39326431›Full record

ArticleThe lancet. Gastroenterology & hepatology2024

Spleen stiffness measurement by vibration-controlled transient elastography at 100 Hz for non-invasive predicted diagnosis of clinically significant portal hypertension in patients with compensated advanced chronic liver disease: a modelling study.

Mathias Jachs, Aitor Odriozola, Fanny Turon, Lucile Moga, Luis Téllez, Petra Fischer, Dario Saltini, Wilhelmus J Kwanten, Maria Grasso, Elba Llop and 25 more

Abstract readMulticenter Study
PubMed Publisher
In one paragraph

Article in The lancet. Gastroenterology & hepatology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 49 papers.

0numbers the graph read from it
0cells of the map it votes in
49citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

49 citing papers in PubMed.

  1. Liver and Spleen Stiffness as Non-Invasive Tools Assessing Liver Congestion in Patients With Budd-Chiari Syndrome.Liver international : official journal of the International Association for the Study of the Liver · 2026
    Article
  2. Article
  3. Review
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  5. Author's Reply: Reconsidering splenic stiffness measurement for non-invasive esophageal variceal screening in cirrhosis.Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology · 2026
    Article
  6. Changes in SSM Assessed via 100 Hz-VCTE Are Associated With Acute HVPG-Response to i.v. Propranolol: A European Multicentre Study.Liver international : official journal of the International Association for the Study of the Liver · 2026
    Article
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  9. Review
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  11. Noninvasive Tests for Predicting Decompensation in Compensated Advanced Chronic Liver Disease: A Comprehensive Review.Liver international : official journal of the International Association for the Study of the Liver · 2026
    Review
  12. Article
  13. Preventing First and Further Decompensation in Advanced Chronic Liver Disease.Liver international : official journal of the International Association for the Study of the Liver · 2026
    Review
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

35 authors.

Mathias JachsDivision of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria; Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria; Department of Medicine III and Clinical Research Group Mechanisms in Portal Hypertension, Medical University of Vienna, Vienna, Austria.
Aitor OdriozolaGastroenterology and Hepatology Department, Clinical and Translational Research in Digestive Diseases, Valdecilla Research Institute, Marqués de Valdecilla University Hospital, Santander, Spain.
Fanny TuronBarcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas, University of Alcalá, Madrid, Spain; European Reference Network on Rare Liver Disorders, Hamburg, Germany.
Lucile MogaInstitut National de la Santé et de la Recherche Médicale, Centre de Recherche sur l'Inflammation, Université Paris-Cité, Unité Mixte de Recherche 1149, Paris, France; Service d'Hépatologie, Assistance Publique-Hôpitaux de Paris, Hôpital Beaujon, Départements Médico-Universitaires Maladies de l'Appareil Digestif, Centre de Référence des Maladies Vasculaires du Foie, French Network for Rare Liver Diseases and European Reference Network on Rare Liver Disorders, Paris, France.
Luis TéllezInstituto Ramón y Cajal de Investigación Sanitaria, University of Alcalá, Madrid, Spain; Gastroenterology and Hepatology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.
Petra FischerThird Medical Clinic, Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
Dario SaltiniGastroenterology Unit, Department of Medical Specialties, University of Modena, Reggio Emilia, and Azienda Ospedaliero-Universitaria di Modena, Modena, Italy; Severe Liver Diseases Unit, Department of Medical Specialties, University of Modena, Reggio Emilia, and Azienda Ospedaliero-Universitaria di Modena, Modena, Italy.
Wilhelmus J KwantenEuropean Reference Network on Rare Liver Disorders, Hamburg, Germany; Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium; Laboratory of Experimental Medicine and Pediatrics-Gastroenterology and Hepatology, University of Antwerp, Antwerp, Belgium.
Maria GrassoGastroenterology and Hepatology Unit, Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialities, Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza G D'Alessandro, University of Palermo, Palermo, Italy.
Elba LlopDepartment of Gastroenterology and Hepatology, Puerta de Hierro University Hospital, Puerta de Hierro Health Research Institute, Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas, Universidad Autonoma de Madrid, Madrid, Spain.
Yuly P MendozaDepartment of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.
Angelo ArmandiMetabolic Liver Disease Research Program, Department of Medicine, University Medical Center Mainz, Mainz, Germany; Division of Gastroenterology and Hepatology, Department of Medical Sciences, University of Turin, Turin, Italy.
Julia ThalhammerDivision of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria; Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria.
Carlos PardoBarcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas, University of Alcalá, Madrid, Spain; European Reference Network on Rare Liver Disorders, Hamburg, Germany.
Antonio ColecchiaGastroenterology Unit, Department of Medical Specialties, University of Modena, Reggio Emilia, and Azienda Ospedaliero-Universitaria di Modena, Modena, Italy.
Federico RavaioliIstituto di Ricovero e Cura a Carattere Scientifico Azienda Ospedaliero and Department of Medical and Surgical Sciences, Universitaria di Bologna, European Reference Network on Hepatological Diseases, Bologna, Italy.
Benjamin MaasoumyDepartment of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
Wim LalemanDepartment of Gastroenterology and Hepatology, Section of Liver and Biliopancreatic Disorders and Liver Transplantation, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium; Medizinische Klinik B, Universitätsklinikum Münster, Münster University, Münster, Germany.
José PresaLiver Unit, Hospital Center of Trás-os-Montes and Alto Douro, Vila Real, Portugal.
Jörn M SchattenbergMetabolic Liver Disease Research Program, Department of Medicine, University Medical Center Mainz, Mainz, Germany; Department of Internal Medicine II, Saarland University Medical Center, Homburg, Germany.
Annalisa BerzigottiDepartment of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.
José L CallejaDepartment of Gastroenterology and Hepatology, Puerta de Hierro University Hospital, Puerta de Hierro Health Research Institute, Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas, Universidad Autonoma de Madrid, Madrid, Spain.
Vincenza CalvarusoGastroenterology and Hepatology Unit, Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialities, Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza G D'Alessandro, University of Palermo, Palermo, Italy.
Sven FrancqueDepartment of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium; Laboratory of Experimental Medicine and Pediatrics-Gastroenterology and Hepatology, University of Antwerp, Antwerp, Belgium.
Filippo SchepisGastroenterology Unit, Department of Medical Specialties, University of Modena, Reggio Emilia, and Azienda Ospedaliero-Universitaria di Modena, Modena, Italy; Severe Liver Diseases Unit, Department of Medical Specialties, University of Modena, Reggio Emilia, and Azienda Ospedaliero-Universitaria di Modena, Modena, Italy.
Bogdan ProcopetThird Medical Clinic, Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
Agustín AlbillosInstituto Ramón y Cajal de Investigación Sanitaria, University of Alcalá, Madrid, Spain; Gastroenterology and Hepatology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.
Pierre-Emmanuel RautouInstitut National de la Santé et de la Recherche Médicale, Centre de Recherche sur l'Inflammation, Université Paris-Cité, Unité Mixte de Recherche 1149, Paris, France; Service d'Hépatologie, Assistance Publique-Hôpitaux de Paris, Hôpital Beaujon, Départements Médico-Universitaires Maladies de l'Appareil Digestif, Centre de Référence des Maladies Vasculaires du Foie, French Network for Rare Liver Diseases and European Reference Network on Rare Liver Disorders, Paris, France.
Juan C García-PagánBarcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas, University of Alcalá, Madrid, Spain; European Reference Network on Rare Liver Disorders, Hamburg, Germany.
Ángela PuenteGastroenterology and Hepatology Department, Clinical and Translational Research in Digestive Diseases, Valdecilla Research Institute, Marqués de Valdecilla University Hospital, Santander, Spain.
José I ForteaGastroenterology and Hepatology Department, Clinical and Translational Research in Digestive Diseases, Valdecilla Research Institute, Marqués de Valdecilla University Hospital, Santander, Spain.
Thomas ReibergerDivision of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria; Department of Medicine III and Clinical Research Group Mechanisms in Portal Hypertension, Medical University of Vienna, Vienna, Austria.
Mattias MandorferDivision of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria; Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria; Department of Medicine III and Clinical Research Group Mechanisms in Portal Hypertension, Medical University of Vienna, Vienna, Austria. Electronic address: mattias.mandorfer@meduniwien.ac.at.
SSM-100Hz/ACLD Study Group
Baveno Cooperation

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIn patients with compensated advanced chronic liver disease (cACLD), risk of clinically significant portal hypertension (CSPH) can be estimated by applying non-invasive tests such as liver stiffness measurement (LSM), platelet count, and, in some cases, BMI. We aimed to assess the diagnostic utility of spleen stiffness measurement (SSM) at 100 Hz as a standalone non-invasive test for CSPH and to evaluate its incremental value compared with the ANTICIPATE±NASH model in patients with cACLD.

methodsFor this modelling study, patients were recruited from 16 expert centres in Europe. Patients who underwent characterisation by hepatic venous pressure gradient (HVPG) and non-invasive tests (ie, LSM, platelet count, and SSM at 100 Hz) at one of the participating centres between Jan 1, 2020, and Dec 31, 2023, were considered for inclusion. Only patients aged 18 years or older with Child-Pugh class A cACLD, shown by LSM 10 kPa or more or F3 or F4 fibrosis on liver histology, were included. The overall cohort was split into the derivation cohort (patients recruited between Jan 1, 2020, and Dec 31, 2022) and the temporal validation cohort (patients recruited between Jan 1, 2023, and Dec 31, 2023). The ANTICIPATE±NASH model was applied to assess individual CSPH probability and SSM was investigated as a standalone non-invasive test for CPSH; in combination with platelet count and BMI; and in a full model of SSM, LSM, platelet count, and BMI (ie, the Non-Invasive CSPH Estimated Risk [NICER] model). All models were binary logistic regression models. The primary outcome was CSPH. We evaluated the discriminative utility of the models by calculating the area under the receiver operating characteristics curve (AUC) and creating calibration plots and calibration of intercept, slope, and integrated calibration index.

findings407 patients with cACLD were included, 202 (50%) in the derivation cohort and 205 (50%) in the validation cohort. Median age was 60·0 years (IQR 55·0-66·8); 275 (68%) of 407 patients were male and 132 (32%) were female. 164 (40%) of 407 patients had metabolic dysfunction-associated steatotic liver disease (MASLD), 133 (33%) had MASLD with increased alcohol intake or alcohol-related liver disease, 75 (18%) had viral hepatitis (61 [81%] of whom had sustained virologic response of hepatitis C virus or suppression of hepatitis B virus DNA), and 35 (9%) had other chronic liver diseases. 241 (59%) patients had CSPH. Median SSM was 45·0 kPa (32·1-65·4) and LSM was 21·4 kPa (14·1-31·6). SSM and LSM had similar AUCs for prediction of CSPH in the derivation cohort (0·779 [95% CI 0·717-0·842] vs 0·781 [0·718-0·844]; p=0·97) and in the validation cohort (0·830 [0·772-0·887] vs 0·804 [0·743-0·864]; p=0·50). The SSM-based model comprising platelet count and BMI had a similar AUC as the ANTICIPATE±NASH model in both the derivation cohort (0·849 [0·794-0·903] vs 0·849 [0·794-0·903]; p=0·999) and in the validation cohort (0·873 [0·819-0·922] vs 0·863 [0·810-0·916]; p=0·75). The NICER model had a significantly higher AUC for prediction of CSPH than the ANTICIPATE±NASH model in the derivation cohort (0·889 [0·843-0·934] vs 0·849 [0·794-0·903]; p=0·022) and in the validation cohort (0·906 [0·864-0·946] vs 0·863 [0·810-0·916]; p=0·012).

interpretationThe addition of SSM to LSM, BMI, and platelet count outperformed the ANTICIPATE±NASH model for CSPH risk stratification in our cohort of contemporary patients with cACLD. SSM improves the non-invasive diagnosis of CSPH, supporting its implementation into clinical practice.

fundingEchosens.

Indexed as

Elasticity Imaging TechniquesHypertension, PortalSpleenAgedChronic DiseaseFemaleHumansLiver CirrhosisLiver DiseasesMaleMiddle AgedPlatelet CountPredictive Value of TestsROC CurveVibration

Identifiers

PMID39326431

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.