Clin Mol Hepatol.
2025 Jan;31(1):105-118. 10.3350/cmh.2024.0198.
Carvedilol to prevent hepatic decompensation of cirrhosis in patients with clinically significant portal hypertension stratified by new non-invasive model (CHESS2306)
- Liu C1,2
- You H3
- Zeng QL4
- Wong YJ5,6
- Wang B3
- Grgurevic I7
- Liu C8,9,10
- Yim HJ11
- Gou W12
- Dong B13
- Ju S14
- Guo Y8
- Yu Q13
- Hirooka M15
- Enomoto H16
- Hanafy AS17
- Cao Z18
- Dong X12
- LV J19
- Kim TH11
- Koizumi Y15
- Hiasa Y15
- Nishimura T16,20
- Iijima H16,20
- Xu C21
- Dai E22
- Lan X23
- Lai C24
- Liu S25
- Wang F24
- Guo Y26
- Lv J23
- Zhang L27
- Wang Y28
- Xie Q18
- Shao C29
- Liu Z12
- Ravaioli F30,31
- Colecchia A30
- Li J32
- Teng GJ
2,33 - Qi X1,2
- Affiliations
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- 1Liver Disease Center of Integrated Traditional Chinese and Western Medicine, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging & Interventional Radiology (Southeast University), Nanjing, China
- 2Basic Medicine Research and Innovation Center of Ministry of Education, Zhongda Hospital, Southeast University; State Key Laboratory of Digital Medical Engineering, Nanjing, China
- 3Liver Research Center, Beijing Friendship Hospital, Capital Medical University, State Key Lab of Digestive Health, National Clinical Research Center of Digestive Diseases, Beijing, China
- 4Department of Infectious Diseases and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- 5Department of Gastroenterology & Hepatology, Changi General Hospital, Singapore
- 6Duke-NUS Medical School, Singapore
- 7University Hospital Dubrava, University of Zagreb School of Medicine and Faculty of Pharmacy and Biochemistry, Zagreb, Croatia
- 8Institute of Liver Diseases, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- 9Shanghai Key Laboratory of Traditional Chinese Clinical Medicine, Shanghai, China
- 10Key Laboratory of Liver and Kidney Diseases, Ministry of Education, Shanghai, China
- 11Division of Gastroenterology and Hepatology, Korea University Ansan Hospital, Ansan, Korea
- 12Qingdao Sixth People’s Hospital, Qingdao, China
- 13Department of Ultrasound, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- 14Department of Radiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
- 15Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Japan
- 16Division of Hepatobiliary and Pancreatic Diseases, Department of Gastroenterology, Hyogo Medical University, Nishinomiya, Hyogo, Japan
- 17Division of Gastroenterology, Hepatology and Endoscopy, Internal Medicine, Zagazig University Faculty of Medicine, Zagazig, Egypt
- 18Department of Infectious Disease, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- 19Department of Liver Disease, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- 20Ultrasound Imaging Center, Hyogo Medical University, Nishinomiya, Hyogo, Japan
- 21Department of Radiology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
- 22Hebei Key Laboratory of Immune Mechanism of Major Infectious Diseases and New Technology of Diagnosis and Treatment, The Fifth Hospital of Shijiazhuang, Shijiazhuang, China
- 23Department of Infectious Diseases, Lishui People’s Hospital, Lishui, China
- 24Shenzhen Third People’s Hospital, Shenzhen, China
- 25Department of Infectious Diseases, Qufu People’s Hospital, Qufu, China
- 26Department of Hepatology, The Third People’s Hospital of Taiyuan, Taiyuan, China
- 27Department of Infectious Diseases, The First Hospital of Lanzhou University, Lanzhou, China
- 28Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
- 29Lishui People’s Hospital, Lishui, China
- 30Gastroenterology Unit, University Hospital of Modena, Department of Medical Specialities, University of Modena & Reggio Emilia, Modena, Italy
- 31Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- 32Department of Infectious Diseases, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
- 33Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
- KMID: 2563414
- DOI: http://doi.org/10.3350/cmh.2024.0198
Abstract
- Backgrounds/Aims
Non-invasive models stratifying clinically significant portal hypertension (CSPH) are limited. Herein, we developed a new non-invasive model for predicting CSPH in patients with compensated cirrhosis and investigated whether carvedilol can prevent hepatic decompensation in patients with high-risk CSPH stratified using the new model.
Methods
Non-invasive risk factors of CSPH were identified via systematic review and meta-analysis of studies involving patients with hepatic venous pressure gradient (HVPG). A new non-invasive model was validated for various performance aspects in three cohorts, i.e., a multicenter HVPG cohort, a follow-up cohort, and a carvediloltreating cohort.
Results
In the meta-analysis with six studies (n=819), liver stiffness measurement and platelet count were identified as independent risk factors for CSPH and were used to develop the new “CSPH risk” model. In the HVPG cohort (n=151), the new model accurately predicted CSPH with cutoff values of 0 and –0.68 for ruling in and out CSPH, respectively. In the follow-up cohort (n=1,102), the cumulative incidences of decompensation events significantly differed using the cutoff values of <–0.68 (low-risk), –0.68 to 0 (medium-risk), and >0 (high-risk). In the carvediloltreated cohort, patients with high-risk CSPH treated with carvedilol (n=81) had lower rates of decompensation events than non-selective beta-blockers untreated patients with high-risk CSPH (n=613 before propensity score matching [PSM], n=162 after PSM).
Conclusions
Treatment with carvedilol significantly reduces the risk of hepatic decompensation in patients with high-risk CSPH stratified by the new model.
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