Spleen Stiffness Measured by 100‐Hz Probe Predicts Decompensation in Patients With Compensated Advanced Chronic Liver Disease

ABSTRACT Background and Aims Although spleen stiffness measurement (SSM) via 100 Hz probe shows promise in predicting hepatic decompensation, its prognostic value across different etiological backgrounds remains insufficiently validated. We evaluated its efficacy in patients with compensated advanced chronic liver disease (cACLD) in a Chinese cohort. Methods This retrospective study included 713 cACLD patients. The optimal SSM cut‐off was derived using the Fine‐Grey competing risk model and validated by bootstrapping. The SSM‐based model was compared against established models using time‐dependent area under the curve (AUC), C‐index, and decision curve analysis (DCA). Results During a median follow‐up of 36.6 months, 28 patients (3.9%) developed decompensation. SSM was an independent predictor (sHR 1.03, 95% CI 1.02–1.05, p < 0.001). An SSM threshold of > 55 kPa was identified and demonstrated excellent stability (bootstrap 95% CI 39.8–57.3 kPa). The SSM > 55 kPa showed comparable discriminative ability to the multivariate NICER model at 1 year (AUC: 0.820 vs. 0.868, p = 0.328) and 2 years (AUC: 0.809 vs. 0.851, p = 0.271). Notably, SSM > 55 kPa significantly outperformed albumin‐combined models (LSM‐ALB, NICER‐ALB) at 1‐year prediction (all p < 0.05). DCA revealed that SSM > 55 kPa provided the highest net clinical benefit across all models. Patients with SSM > 55 kPa had a markedly higher decompensation risk (sHR 8.69, 95% CI 4.15–18.23, p < 0.001), with decompensation incidences of 15.2% vs. 2.0% compared to those below the threshold. Conclusion In cACLD patients, a simple 100‐Hz SSM threshold (> 55 kPa) effectively predicts hepatic decompensation with performance rivalling more complex models, offering a practical, non‐invasive tool for risk stratification.