## 2 Materials and Methods
### Study Protocol  
After the complete clinical examination and the registration of the anthropometric data, biological samples were harvested from the patients, including complete blood counts and liver samples (SGOT, SGPT, GGT, FA, total bilirubin, INR, prothrombin time, albumin).  
Patients were subsequently examined by ultrasound, sitting in dorsal decubitus, after a minimum of 8 h of fasting, by a single operator, using the General Electric LOGIQ 9 (GE Healthcare, Chalfont St Giles, UK) ultrasound equipment, selecting the convex probe, abdominal protocol, and subcostal and intercostal approach. The morphology of the liver was evaluated, with the measurement of the craniocaudal diameter of the hepatic lobes, with the probe on the medioclavicular line, subcostal, in the sagittal plane. The measurement of the portal vein (PV) caliber was performed with the patient in the dorsal or left lateral decubitus, also using the Doppler module, positioning the transducer between the porto-splicing junction and the intrahepatic bifurcation of the PV. Subsequently, the spleen bipolar diameter (SBD) was measured. Another aspect of interest was the exclusion of focal liver injury, biliary obstruction, stasis liver, portal vein thrombosis, and ascites.  
After ultrasonographic examination, the patients were examined by the same operator with the convex probe C1-6-D, in the Elasto 2D-SWE.GE mode; the patient was placed in the dorsal decubitus, with the right upper limb in complete abduction and the approach being intercostal, to obtain an optimal ultrasound window. The ROI was placed subcapsular, in an area without large vessels, for the acquisition of at least 10 shear-wave images. Measurements were then made by placing a circular area at the level of each previously saved image, excluding artifacts. The LS expressed using the Young's modulus (kPa) was saved in the system for each image, and we automatically calculated the median value and IQR. In order to validate the results, the IQR/median value ratio had to be less than 30%. We used a cutoff value of more than 10 kPa for the diagnosis of compensated advanced liver disease (cALD).  
For the evaluation of SS, the patient was positioned in the dorsal or right lateral decubitus, with the upper left limb in abduction, and with the positioning of the probe in an intercostal space, to obtain an appropriate image of the splenic parenchyma--preferably in the middle area, avoiding the large vessels--and then following the same steps described previously in the LS evaluation. Figure 1 shows the acquisition of a measurement at the level of the splenic parenchyma by the 2D-SWE.GE method.  
All patients were examined endoscopically during the same admissions; the standard evaluation was performed by a single operator, and the following endoscopic parameters were recorded for each patient: the presence of grade I, II, or III esophageal varices, the presence of gastric varices, the presence of portal hypertensive gastropathy, and the presence of variceal red marks. The criteria for classification and risk assessment of esophageal varices were established in agreement with the Baveno VI consensus, as follows: (i) grade I: varices that flatten on insufflation; (ii) grade II: non-confluent varices protruding into the lumen upon insufflation; (iii) grade III: confluent varices that do not flatten upon insufflation. Patients without esophageal varices or with grade I varices have no risk of variceal bleeding, while patients with grade II and III varices--or those with grade I varices and red marks--are at high risk of bleeding high-risk varices (HRVs).