A Novel SAVE Score to Stratify Decompensation Risk in Compensated Advanced Chronic Liver Disease (CHESS2102): An International Multicenter Cohort Study.

"CONFLICTS OF INTEREST Guarantor of the article: Xiaolong Qi, MD, PhD. Specific author contributions: Study conception: X.Q. and C.L. Data acquisition: C.L., Z.C., H.Y., Y.J.W., Q.X., M.H., H.E., T.H.K., A.S.H., Y.L., Y.H., X.L., N.K., Y.K., Y.H., T.N., H.I., Y.K.J., H.J.Y., Y.G., L.Z., J.M., M.K., A.J., K.B.T., S.K.S., and X.Q.. Statistical analysis: C.L. and Z.C. Drafting the initial manuscript: C.L., Z.C., and X.Q. Critical review of the manuscript: X.Q. and Y.J.W. All authors reviewed and approved the final version of the manuscript. Financial support: National Natural Science Foundation of China (No. 82000588) and Shanghai Municipal Key Clinical Specialty (shslczdzk01103). The funding sources were not involved in study design, data collection, analysis and interpretation of the data, or writing of the report or decision to submit for publication. Potential competing interests: None to report.Study HighlightsWHAT IS KNOWN✓ The annual risk of hepatic decompensation varies with disease etiology from 4% to more than 10% in patients with compensated advanced chronic liver disease (cACLD).✓ The severity of portal hypertension assessed through the invasive measurement of hepatic venous pressure gradient (HVPG) is the best validated predictor of decompensation in cACLD.✓ Endoscopic surveillance for varices and liver stiffness measured by transient elastography are suboptimal alternatives to HVPG for the prediction of decompensation.WHAT IS NEW HERE✓ In an international collaboration involving 1,252 patients with cACLD, a novel score incorporating Stiffness of liver, Albumin, Varices, and platElets (SAVE) predicts hepatic decompensation better than albumin-bilirubin, albumin-bilirubin-FIB-4, ANTICIPATE model, Baveno VII criteria, Rete Sicilia Selezione Terapia–hepatitis C virus criteria, and Model for End-stage Liver Disease scores.✓ The SAVE score stratified patients with cACLD into low-risk, middle-risk, and high-risk groups with a stepwise increase of 3- and 5-year decompensation rates.✓ The SAVE score correlated well with the HVPG value and accurately predicted the presence of clinically significant portal hypertension."

"Financial support: National Natural Science Foundation of China (No. 82000588) and Shanghai Municipal Key Clinical Specialty (shslczdzk01103). The funding sources were not involved in study design, data collection, analysis and interpretation of the data, or writing of the report or decision to submit for publication."

"All the data sets came from studies approved by ethical review boards of respective study sites. The informed consent for the medical information to be used for research was provided by patients or legal delegates from the participating centers. This study followed the Consolidated Standards of Reporting Trials and the Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis guidelines for reports and was registered at the ClinicalTrials.gov (identifier: NCT04975477). All authors had access to the study data and had reviewed and approved the final article."