Noninvasive prediction of clinically significant portal hypertension in metabolic dysfunction-associated steatotic liver disease compared to other chronic liver diseases

Liver biopsy is rarely performed for the diagnosis of compensated advanced chronic liver disease (cACLD) in the current clinical hepatology practice. In the early stage, cACLD presents without portal hypertension, and in the later stage, it presents with portal hypertension. Hepatic venous pressure gradient measurement is the gold standard for diagnosing portal hypertension, but it is rarely used due to its invasive nature. The recent Baveno VII consensus recommends a noninvasive strategy for the diagnosis of cACLD and clinically significant portal hypertension (CSPH). However, there is some uncertainty regarding the diagnostic accuracy of Baveno VII criteria for predicting CSPH among patients with metabolic dysfunction-associated steatotic liver disease (MASLD). This is pertinent as MASLD has become the most important cause of cACLD in the United States. This mini-review outlines the diagnostic performance of Baveno VII criteria and other noninvasive criteria for predicting CSPH in patients with cACLD from MASLD compared to non-MASLD causes.