Evaluation of Portal Hypertension Doppler Parameters after Hepatitis C Virus Eradication in Patients with Definite Fibrosis

Abstract

Backgrounds and aims: Eradication of hepatitis C virus (HCV) infection with direct-acting antivirals (DAAs)nowadays is almost always successful and sustained virological response (SVR) occurs in more than 90% of cases and this prevent more fibrosis and preclude the progression of portal hypertension (PH). We aimed to evaluate the portal hypertensive Doppler parameters as a marker of PH after treatment of HCV with DAAs. Methods: 200 patients with post chronic HCV infection and definite liver fibrosis ≥F2 were included. All patients underwent laboratory investigations (liver function tests, complete blood count and serum creatinine), abdominal ultrasonography (US), portal Doppler US, fibroscan and upper endoscopy examinations. All patients were treated with DAAs for 12 weeks and then reevaluated for laboratory tests, fibroscan and hepatic Doppler US at the end of treatment and 6 months later. Comparison between those investigations at baseline, end of treatment and 6 months after treatment was analyzed. Results: 120 females (60%) and 80 males (40%) were included. Their mean ages were 45.0±12.9; and mean ChildPugh score was 6.35±1.2. The mean baseline value for fibroscan was 16.17±3.9 kPa; thirteen of them (6.5%) were F2, 63 (31.5%) were F3 and 124 (62%) were F4. Liver function tests including serum bilirubin and albumin, prothrombin time and concentration (PT& PC), liver enzymes (ALT and AST) were improved with variable significant values 6 months after treatment. Also Hemoglobin and platelet count were significantly increased both at the end of treatment and 6 months later. Fibroscan values decreased significantly both at the end of treatment and 6 months later (P value= 0.001 and 0.000 respectively). Portal hypertensive parameters including portal vein velocity (PVV), portal volume flow (PVF), portal hypertensive index (PHI), congestion index of portal vein (CI) and Spleno-portal index (SPI) were improved significantly both at the end of treatment and 6 months later (P value= 0.001 and 0.000 respectively, for all parameters). Patients without esophageal varices (OVs) showed more significant degrees of improvement in both fibroscan and portal hypertensive parameters than those with varices. Conclusions: Doppler portal hypertensive parameters, as a marker of portal hypertension, were improved in parallel with the improvement in fibroscan values after viral clearance and its improvement in early conditions in the current study mandate urgent treatment to avoid possible complications.

Impact of sustained virologic response in regression of portal hypertension in Egyptian patients with hepatitis C virus-associated cirrhosis and portal hypertension

“…Regarding portal vein velocity, our results are in line with Soliman et al [ 25 ], where PVV improved significantly from 11.889 ± 3.529 cm/s to 15.094 ± 4.250 cm/s, with ( p -value ≤ 0.001*), as well as Mahmoud et al [ 26 ], where PVV was increased significantly from 13.61 ± 2.53 cm/s at baseline to 14.72±2.67 cm/s at EOT and to 15.81±2.067 cm/s at SVR 48, with p -value ≤ 0.001*.…”

“…In our results, portal vein diameter showed 82.50% sensitivity and 95% specificity at cutoff value (> 13.8 mm), to predict the presence of CSPH in HCV-related liver cirrhosis, while showed 50% sensitivity and 100% specificity, at cutoff value (≤ 14 mm), to predict reversibility of CSPH. These findings are similar to Hagen-Ansert [ 27 ], who reported that a diameter (> 13 mm) was considered as a predictor of PH in patients with cirrhosis, but unlike Mahmoud et al [ 26 ] and Mihai et al [ 28 ], as their results were insignificant regarding PVD.…”