Sex does not impact the performance of non-invasive tests for clinically significant portal hypertension in cACLD

BACKGROUND: Clinically significant portal hypertension (CSPH) denotes the hemodynamic threshold for hepatic decompensation in advanced chronic liver disease (cACLD) and is increasingly diagnosed by noninvasive tests. Although liver stiffness measurement (LSM) by VCTE is affected by body composition, intriguingly, no data on sex differences of its diagnostic or prognostic performance are available. We aimed to address this knowledge gap. METHODS: A total of 420 stable outpatients who underwent HVPG measurement from 2007 to 2022 at the Vienna Hepatic Hemodynamic Lab were included. The sex-specific diagnostic performance of prevailing NITs was evaluated. Moreover, the sex-specific cumulative incidences of first hepatic decompensation were analyzed using competing risk models stratified by the Baveno VII criteria and the sequential Baveno VII-VITRO algorithm. RESULTS: Two-hundred eighty-one (66.9%) patients were male, while 139 (33.1%) were female. LSM performed better in male patients (AUROC = 0.845) than in female patients (AUROC = 0.811; p = 0.447), while for VITRO, the AUROC in female patients (0.854) was higher, as compared to male (0.814) subjects (p = 0.370). The ANTICIPATE ± NASH model exhibited the highest AUROC in both sexes (male = 0.885; female = 0.872; p = 0.755). Finally, Baveno VII criteria and the sequential Baveno VII-VITRO algorithms were similarly effective in ruling-in/out CSPH in males and females. Thus, we observed a comparable diagnostic performance of NITs between the sexes, with no statistically significant differences. Interestingly, female patients classified as "ruled-in" by Baveno VII as well as by sequential Baveno VII-VITRO algorithm showed a trend towards higher decompensation rates, as compared to males. CONCLUSIONS: Individual noninvasive tests and Baveno VII-based algorithms show a similar accuracy for the diagnosis of CSPH and prognostication in males and females.