Sequential 100-Hz spleen stiffness and ANTICIPATE-NASH enhance esophageal varices detection in Thai advanced chronic liver disease

Spleen stiffness measurement (SSM) is an established noninvasive marker of portal hypertension. However, its performance in real-world settings with diverse etiologies remains unclear. This study determined whether a sequential strategy integrating 100-Hz SSM and the BMI-adjusted ANTICIPATE-NASH model improves the detection of esophageal varices (EV) in patients with advanced chronic liver disease (ACLD). This diagnostic accuracy study was conducted at Vajira Hospital, Thailand, during August 2025 to Jaunary 2026. Ninety-one patients with ACLD underwent vibration-controlled transient elastography (100-Hz SSM and liver stiffness measurement [LSM]) followed by endoscopy within 3 months. Diagnostic performance was assessed with subgroup analyses performed according to SSM strata and nonselective beta-blocker (NSBB) exposure. EV were present in 35 patients (38.5%), including 9 patients (25.7%) with high-risk EV. SSM demonstrated the strongest overall discriminative ability (AUROC 0.81), with an optimal cutoff of ≥ 40.6 kilopascals yielding 77.1% sensitivity and 76.8% specificity. LSM and the ANTICIPATE-NASH score showed modest performance (AUROC 0.70). Performance varied across SSM strata. In patients with SSM < 21 kPa, ANTICIPATE-NASH showed a high discrimination (AUROC 0.86). In patients not receiving NSBBs, the incremental value of ANTICIPATE-NASH persisted in the low-SSM subgroup. Sequential SSM with ANTICIPATE-NASH, enhances diagnostic precision for detecting varices, particularly in individuals with lower spleen stiffness.