ABC: a novel algorithm to stratify decompensation risk in patients with cACLD (CHESS2102): an international, multicenter cohort study

Abstract

Background and aims: Liver-related death is preceded by clinical decompensation; therefore, the risk stratification of decompensation in compensated advanced chronic liver disease (cACLD) is extraordinary significant. This study intended to investigate a novel algorithm to stratify the decompensation risk in patients with cACLD.

Method: The international, multicenter study included two cohorts from January 2009 to August 2020. In training cohort, the unfavorable Baveno VI criteria patients were used to develop the novel CHESS criteria to stratify decompensation risk. The Algorithm based on Baveno VI criteria plus CHESS criteria (ABC model) was validated in validation cohort.

Results: A total of 1118 cACLD patients were enrolled in training cohort and validation cohort. In training cohort, multivariate analysis revealed that liver stiffness measurement (LSM), platelet count (PLT), albumin, alanine aminotransferase (ALT) and varices were the independent risk factors for hepatic decompensation. The novel CHESS criteria was produced, and <−4.4, −4.4 to −3.1 and >−3.1 indicated the low risk, medium risk, and high risk of decompensation, with a 3 year-time-dependent area under the curve (tAUC) of 0.851 (0.800–0.901) (Figure 1 A). In validation cohort, the 3 year-tAUC of ABC model was 0.843 (0.742–0.943) (Figure 1 B).

Conclusion: The ABC model can stratify the risk of decompensation in cACLD. HVPG evaluation can be waived in both low risk and high risk cACLD patients as they can be managed by Baveno VI criteria and non-selective β-blockers intervention, respectively, and the remaining medium risk patients need further HVPG evaluation.