{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T19:34:14Z","timestamp":1792611254983,"version":"4.5.0"},"reference-count":40,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The World Federation for Ultrasound in Medicine and Biology (WFUMB) guidance update 2024 proposed a \u2018rule\u2010of\u20104\u2019 using ARFI liver stiffness measurement (LSM) to stratify the risk of decompensation events. This rule identifies advanced chronic liver disease (ACLD) at a threshold of \u2265\u200913\u2009kPa and indicates a high probability of clinically significant portal hypertension (CSPH) above 21\u2009kPa.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We prospectively enrolled 187 patients undergoing same\u2010day SSI\u20102D\u2010LSM (Aixplorer SuperSonic Imagine) and hepatic venous pressure gradient (HVPG) measurement. Patients were stratified into three LSM groups &lt;\u200913\u2009kPa, 13\u201321\u2009kPa and &gt;\u200921\u2009kPa and followed for decompensation events for 1\u2009year (Y1).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The cohort comprised 31 (16.6%) patients with LSM &lt;\u200913\u2009kPa (non\u2010ACLD); 33 (17.6%) LSM 13\u201321\u2009kPa (ACLD) and 123 (65.8%) LSM &gt;\u200921\u2009kPa (high CSPH probability). The corresponding median HVPG values were 5 [IQR: 3\u20137] vs. 10 [7\u201314] vs. 17 [13\u201321] mmHg, respectively, and the corresponding CSPH prevalence was 6.5%, 54.5% and 91.9%. In ROC analysis to predict CSPH, SSI\u20102D\u2010LSM demonstrated high accuracy (AUC: 0.83). Validating the new WFUMB extension of the \u2018rule\u2010of\u20104\u2019, the recommended &gt;\u200921\u2009kPa threshold identified CSPH with a specificity of 80.0% and a PPV of 83.1%. In competing risk analysis, the Y1\u2010decompensation rate was 0%, 10% and 24.7% of patients in the &lt;\u200913\u2009kPa, 13\u201321\u2009kPa and &gt;\u200921\u2009kPa groups, respectively. For prediction of Y1\u2010decompensation risk in the compensated ACLD (cACLD) subgroup, HVPG demonstrated the highest predictive accuracy (AUC: 0.92), while SSI\u20102D\u2010LSM (AUC: 0.75) performed similarly to vibration\u2010controlled transient elastography (VCTE: AUC: 0.77; AUC\u2010comparison:\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.837).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The WFUMB \u2018rule\u2010of\u20104\u2019 for ARFI\u2010LSM allows for accurate and point\u2010of\u2010care non\u2010invasive risk stratification of patients with liver disease. Specifically, the short\u2010term risk of decompensation starts at SSI\u20102D\u2010LSM\u2009\u2265\u200913\u2009kPa and becomes considerable at SSI\u20102D\u2010LSM\u2009&gt;\u200921\u2009kPa (indicating high CSPH probability). These findings support the broader implementation of ARFI\u2010LSM for risk assessment in clinical routine.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/liv.70614","type":"journal-article","created":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T09:44:32Z","timestamp":1775727872000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Prognostication of Liver Disease Patients via the\n                    <scp>WFUMB<\/scp>\n                    \u2018Rule\u2010of\u20104\u2019 Algorithm Using\n                    <scp>SSI<\/scp>\n                    \u2010\n                    <scp>2D<\/scp>\n                    \u2010\n                    <scp>SWE<\/scp>\n                    \u2010Based Liver Stiffness Measurement"],"prefix":"10.1111","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-7504-8506","authenticated-orcid":false,"given":"Christian","family":"Sebesta","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine III Medical University of Vienna  Vienna Austria"},{"name":"Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Internal Medicine III Medical University of Vienna  Vienna Austria"},{"name":"LBG Clinical Research Group MOTION Medical University of Vienna  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1736-3699","authenticated-orcid":false,"given":"Georg","family":"Kramer","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine III Medical University of Vienna  Vienna Austria"},{"name":"Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Internal Medicine III Medical University of Vienna  Vienna Austria"},{"name":"LBG Clinical Research Group MOTION Medical University of Vienna  Vienna Austria"},{"name":"Christian\u2010Doppler Laboratory for Portal Hypertension and Liver Fibrosis Medical University of Vienna  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4615-915X","authenticated-orcid":false,"given":"Nina","family":"Dominik","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine III Medical University of Vienna  Vienna Austria"},{"name":"Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Internal Medicine III Medical University of Vienna  Vienna Austria"},{"name":"LBG Clinical Research Group MOTION Medical University of Vienna  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3403-3372","authenticated-orcid":false,"given":"Benedikt S.","family":"Hofer","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine III Medical University of Vienna  Vienna Austria"},{"name":"Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Internal Medicine III Medical University of Vienna  Vienna Austria"},{"name":"LBG Clinical Research Group MOTION Medical University of Vienna  Vienna Austria"},{"name":"Christian\u2010Doppler Laboratory for Portal Hypertension and Liver Fibrosis Medical University of Vienna  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6708-3061","authenticated-orcid":false,"given":"Lorenz","family":"Balcar","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine III Medical University of Vienna  Vienna Austria"},{"name":"Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Internal Medicine III Medical University of Vienna  Vienna Austria"},{"name":"LBG Clinical Research Group MOTION Medical University of Vienna  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Th\u00f6ne","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine III Medical University of Vienna  Vienna Austria"},{"name":"Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Internal Medicine III Medical University of Vienna  Vienna Austria"},{"name":"LBG Clinical Research Group MOTION Medical University of Vienna  Vienna 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F.","family":"St\u00e4ttermayer","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine III Medical University of Vienna  Vienna Austria"},{"name":"Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Internal Medicine III Medical University of Vienna  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Trauner","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine III Medical University of Vienna  Vienna Austria"},{"name":"LBG Clinical Research Group MOTION Medical University of Vienna  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2330-0017","authenticated-orcid":false,"given":"Mattias","family":"Mandorfer","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine III Medical University of Vienna  Vienna Austria"},{"name":"Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Internal Medicine III Medical University of Vienna  Vienna Austria"},{"name":"LBG Clinical Research Group MOTION Medical University of Vienna  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Reiberger","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine III Medical University of Vienna  Vienna Austria"},{"name":"Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Internal Medicine III Medical University of Vienna  Vienna Austria"},{"name":"LBG Clinical Research Group MOTION Medical University of Vienna  Vienna Austria"},{"name":"Christian\u2010Doppler Laboratory for Portal Hypertension and Liver Fibrosis Medical University of Vienna  Vienna 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