Clinically significant portal hypertension (CSPH) is a crucial prognostic determinant for liver-related events (LREs) in patients with compensated viral cirrhosis. Liver stiffness measurement (LSM)-related markers may help to predict the risk of LREs.To evaluate the value of LSM and its composite biomarkers [LSM-platelet ratio (LPR), LSM-albumin ratio (LAR)] in predicting LREs.This study retrospectively enrolled compensated viral cirrhosis patients with CSPH. The Cox regression model was employed to examine the prediction of LSM, LPR, and LAR for LREs. The model performance was assessed through receiver operating characteristic, decision curve, and time-dependent area under the curve analysis. The Kaplan-Meier curve was used to evaluate the cumulative incidence of LREs, and further stratified analysis of different LREs was performed.A total of 598 patients were included, and 319 patients (53.3%) developed LREs during follow-up. Multivariate proportional hazards modeling demonstrated that LSM, LPR, and LAR were independent predictors of LREs. LPR had better performance in predicting LREs than LAR and LSM (area under the curve = 0.780, 0.727, 0.683, respectively, all P < 0.05). The cumulative incidence of LREs in the high-risk group were significantly higher than that in the low-risk group (P < 0.001). Among the different LREs, LPR was superior to LSM and LAR in predicting liver decompensation, while the difference in predicting hepatocellular carcinoma and liver-related death was relatively small.LPR is superior to LSM and LAR in predicting LREs in compensated viral cirrhosis patients with CSPH, especially in predicting liver decompensation.©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.