Predicting hepatic decompensation using non-invasive tests in a contemporary multicentre cohort of patients with cACLD.

Background & Aims The NICER (liver and spleen stiffness by vibration-controlled transient elastography (VCTE), platelet count, and body mass index) and the ANTICIPATE±NASH models predict clinically significant portal hypertension (CSPH) in compensated advanced chronic liver disease (cACLD). This study reports follow-up data of the NICER cohort, comparing the prognostic utility of non-invasive tests for CSPH (CSPH-NITs) and hepatic venous pressure gradient (HVPG).Methods Child-Turcotte-Pugh A cACLD (liver stiffness ≥10kPa and/or F3/4) patients from 16 European centres undergoing paired HVPG and CSPH-NITs assessment from 2020-2023 were included and followed until incident hepatic decompensation, hepatocellular carcinoma, death, or last visit.Results Three hundred and fifty-eight cACLD patients (MASLD: 40.7%/MetALD/ALD: 32.1%/viral: 16.2%; CSPH prevalence: 62.0%) were included. The cumulative 1-year and 2-year incidences of decompensation were 7.3 (95% CI: 5.9-8.7%) and 12.6 (10.3-14.9%). Albumin levels were a key predictor of decompensation (subdistribution hazard ratio [sHR]: 0.836 [95% CI: 0.779-0.897]) besides either HVPG (albumin-adjusted SHR: 1.126 [1.059-1.198]) or NICER (albumin-adjusted SHR: 1.207 [1.043-1.397]) or ANTICIPATE±NASH (albumin-adjusted SHR: 1.174 [1.003-1.374]). Models comprising albumin alongside HVPG or CSPH-NIT yielded high C-index for decompensation (0.772-0.806). Stratifying patients by a predicted 1-year decompensation-free survival probability of ≥95% or