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World J Hepatol. Sep 27, 2026; 18(9): 124338
Published online Sep 27, 2026. doi: 10.4254/wjh.124338
Splenic stiffness measurement to predict decompensation in compensated advanced chronic liver disease
Sayan Malakar, Akriti Bhardwaj, Sumit Rungta, Jahnvi Dhar, Vishwas Kapoor, Akash Roy, Suprabhat Giri, Virendra Singh, Jayanta Samanta
Sayan Malakar, Akriti Bhardwaj, Sumit Rungta, Department of Gastroenterology, King George’s Medical University, Lucknow 226003, Uttar Pradesh, India
Jahnvi Dhar, Virendra Singh, Department of Gastroenterology and Hepatology, Punjab Institute of Liver and Biliary Sciences, Mohali 160062, Punjab, India
Vishwas Kapoor, Department of Biostatistics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
Akash Roy, Department of Gastrosciences and Liver Transplantation, Apollo Multispeciality Hospital, Kolkata 700054, West Bengal, India
Suprabhat Giri, Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Bhubaneswar 751024, Odisha, India
Jayanta Samanta, Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, Chandīgarh, India
Co-corresponding authors: Sumit Rungta and Virendra Singh.
Author contributions: Malakar S contributed to the conception and design of the manuscript; Malakar S, Roy A, and Giri S drafted the initial manuscript; Rungta S, Singh V, and Samanta J contributed to the critical revision of the initial manuscript; Malakar S, Bhardwaj A, Rungta S, Dhar J, Kapoor V, Roy A, Giri S, Singh V, and Samanta J contributed to the literature review, analysis, data collection, and interpretation; Rungta S and Singh V contributed equally to this article, they are the co-corresponding authors of this manuscript; and all the authors approved the final version of the manuscript.
AI contribution statement: AI was not used in drafting this article.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Ethics King George’s Medical University U.P., approval No. 1444/Ethics/2021.
Clinical trial registration statement: Not applicable.
Informed consent statement: All participants provided written consent prior to study enrollment
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: De-identified patient data will be shared upon reasonable request from the corresponding author.
Corresponding author: Virendra Singh, MD, Professor, Department of Gastroenterology and Hepatology, Punjab Institute of Liver and Biliary Sciences, Phase 3B1, Sector 60, SAS Nagar, Mohali 160062, Punjab, India.
virendrasingh100@hotmail.com
Received: June 12, 2026
Revised: July 27, 2026
Accepted: September 4, 2026
Published online: September 27, 2026
Processing time: 97 Days and 20 Hours
BACKGROUND
The onset of decompensation is an important event in patients with compensated advanced chronic liver diseases (c-ACLD). Splenic stiffness measurement (SSM) is an emerging non-invasive modality for stratifying patients with c-ACLD.
AIM
To determine the utility of SSM to predict one-year decompensation in patients with c-ACLD.
METHODS
In this prospective study, patients with c-ACLD (Baveno VII) were recruited from 2022 to 2024 at a tertiary care center in north India. Subsequently, they underwent baseline SSM using the vibration-controlled transient elastography method with a 100 Hz spleen-dedicated probe. They were followed up for a year to document decompensation and death.
RESULTS
A total of 294 patients were recruited, 63 were excluded and 231 patients were included in the final analysis. The mean age was 45.18 ± 9.73 years, and the majority were women (58.4%). The most common etiology of c-ACLD was chronic hepatitis C infection [75 (32.5%)]. One year-decompensation rate was 8.26% (19 patients). The patients who decompensated had higher SSM and liver stiffness values (69.61 ± 16.27 kPa vs 43.99 ± 14.81 kPa, P < 0.001; and 30.77 ± 11.26 kPa vs 22.68 ± 7.02 kPa, P < 0.001, respectively). In the Cox proportional hazards model, SSM predicted one-year decompensation [hazard ratio: 1.073 (1.049-1.097), P < 0.001]. With a cut-off 57.5 kPa, SSM has the highest sensitivity (82%), specificity (87.5%), positive predictive value (98.26%), negative predictive value (36.21%) and diagnostic accuracy (82.61%) for predicting decompensation in patients with c-ACLD.
CONCLUSION
A SSM cut-off of 57.5 kPa has a sensitivity and specificity of 82% and 87.5%, respectively, for predicting one-year decompensation in patients with c-ACLD.
Core Tip: The onset of decompensation is an important event in patients with compensated advanced chronic liver diseases (c-ACLD). The presence of clinically significant portal hypertension is associated with a higher risk of decompensation in patients with c-ACLD. Hepatic venous pressure gradient measurement is used to risk-stratify such patients. Hepatic venous pressure gradient measurement is an invasive investigation; hence, liver and splenic stiffness measurements are emerging as useful non-invasive tests to predict clinically significant portal hypertension and risk of decompensation. Herein, we have explored the role of splenic stiffness measurement in predicting decompensation in patients with c-ACLD.
