Advanced liver disease is the second most common cause of lost working years, as it disproportionately affects young patients. Possible complications of these diseases can often be traced back to high blood pressure in the blood circulation of the liver - portal hypertension. Under the leadership of Mattias Mandorfer from the Clinical Division of Gastroenterology and Hepatology at MedUni Vienna and University Hospital Vienna, the NICER model has now been developed, which can calculate the percentage probability of the presence of portal hypertension without an invasive procedure.
Complications of liver disease caused by high blood pressure in the liver include abdominal fluid (ascites) or internal bleeding. If portal hypertension is detected early, the risk of complications can be halved by initiating treatment with non-selective beta-blockers.
Until now, measuring the pressure in the liver by means of minimally invasive insertion of a balloon catheter into the liver has been the most accurate method, but requires expertise that is only available at a few centers worldwide. A study group from the Baveno Cooperation, consisting of 16 such centers and led by Mattias Mandorfer, has now developed a new model based on non-invasive parameters that can determine the presence of portal hypertension with maximum accuracy. The so-called Non-Invasive Clinically Significant Portal Hypertension Risk Estimate (NICER) model calculates the percentage probability of the presence of portal hypertension and thus enables the identification of patients with an increased risk of complications and the prompt treatment of these with beta blockers.
Spleen stiffness as an indicator of high blood pressure in the liver
In the current study, the research group from the Clinical Division of Gastroenterology and Hepatology (Department of Medicine III) analyzed patients with liver stiffness of at least 10 kilopascals, which corresponds to advanced liver disease, but who did not yet have any complications. With the help of spleen stiffness, measured using non-invasive elastography, an imaging technique that measures the stiffness or elasticity of tissue, the diagnosis of portal hypertension was significantly improved compared to the previous standard - a combination of liver stiffness and blood platelet count. “Spleen stiffness had already been the subject of research for several years, but it was only recently that a technical improvement became available that enabled its widespread clinical use,” explains lead author Mathias Jachs.
Meaningful results even with a “fatty liver”
The majority of previous studies on the non-invasive diagnosis of portal hypertension were based on patient groups that were recruited a long time ago and often suffered from viral hepatitis. Due to therapeutic advances in this field and the increase in metabolic syndrome, a collective term for common risk factors (obesity, high blood sugar, elevated blood lipid levels, etc.), steatotic liver disease, commonly known as fatty liver, is the leading cause of portal hypertension. “Initially, there was uncertainty about the validity of non-invasive methods in these patients. Our study is based on recently enrolled patients from University Hospital Vienna and other European expert centers, most of whom suffer from steatotic liver disease. However, by taking BMI into account, this does not affect the accuracy of our diagnostic model”.
The study in question is part of the clinical research group (KFG) MOTION, in which Mathias Jachs and Mattias Mandorfer are involved as Work Package Leader and Deputy Chair respectively, and was published in the leading specialist journal The Lancet Gastroenterology & Hepatology. By coordinating the study, MedUni Vienna made another important contribution to the upcoming 2026 update of the international consensus on portal hypertension (Baveno VIII), in which Mathias Jachs and Mattias Mandorfer are also involved. The NICER model could thus be widely adopted in clinical practice.
Publication: The Lancet Gastroenterology & Hepatology
Spleen stiffness measurement by vibration-controlled transient elastography at 100 Hz for non-invasive predicted diagnosis of clinically significant portal hypertension in patients with compensated advanced chronic liver disease: a modelling study.
Mathias Jachs, Aitor Odriozola, Fanny Turon, Lucile Moga, Luis Téllez, Petra Fischer, Dario Saltini, Wilhelmus J Kwanten, Maria Grasso, Elba Llop, Yuly P Mendoza, Angelo Armandi, Julia Thalhammer, Carlos Pardo, Antonio Colecchia, Federico Ravaioli, Benjamin Maasoumy, Wim Laleman, José Presa, Jörn M Schattenberg, Annalisa Berzigotti, José L Calleja, Vincenza Calvaruso, Sven Francque, Filippo Schepis, Bogdan Procopet, Agustín Albillos, Pierre-Emmanuel Rautou, Juan C García-Pagán, Ángela Puente, José I Fortea, Thomas Reiberger, Mattias Mandorfer on behalf of the SSM-100Hz/ACLD Study Group, and the Baveno Cooperation
doi.org/10.1016/S2468-1253(24)00234-6