Liver stiffness accurately predicts portal hypertension related complications in patients with chronic liver disease: A prospective study

Robic, Marie Angèle; Procopeţ, Bogdan; Métivier, Sophie; Péron, Jean Marie; Sèlves, Janick; Vinel, Jean Pierre; Bureau, Christophe

doi:10.1016/j.jhep.2011.01.051

Cited by 274 publications

(205 citation statements)

References 31 publications

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“…Similarly, McNemar-Bowker test was used for 3 ϫ 3 contingency table for assessing differences in the proportion of misclassified patients with 2 cutoffs of different noninvasive tests. In addition, the performance of previously published cutoffs for the identification of CSPH and varices derived from prospective studies was tested; namely we tested 13.6 kPa 29 and 21.1 kPa 30,31 for the prediction of CSPH, and 17.6 kPa for the prediction of varices. 29 Statistical analysis was performed with SPSS 16.0 package (SPSS, Chicago, IL), CIA software (v 2.2.0, University of Southampton, Southampton, UK) and MedCalc software (version 12.2.1.0, Belgium).…”

Section: Discussionmentioning

confidence: 99%

Elastography, Spleen Size, and Platelet Count Identify Portal Hypertension in Patients With Compensated Cirrhosis

et al. 2013

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BACKGROUND & AIMS:Noninvasive methods are needed to identify clinically significant portal hypertension (CSPH) and esophageal varices (EVs) in patients with compensated cirrhosis. We looked for markers of the presence of CSPH and EVs in patients with cirrhosis. METHODS: We performed a cross-sectional study that included a training set of 117 patients with compensated cirrhosis, confirmed by histology, from a tertiary referral center. Spleen diameter was measured by ultrasound and liver stiffness (LS) was measured by transient elastography; endoscopy was used as the standard for detection of EVs and measurements of hepatic venous pressure gradient were used as the standard for identifying CSPH. We assessed the ability of platelet count, spleen diameter, LS, and combinations of these factors (ie, ratio of platelet count to spleen size, and LS ϫ spleen size/platelet count [LSPS]) to identify patients with CSPH and EV. The analysis included 2 new statistical models: the PH risk score and the varices risk score. Results were validated using an independent series of 56 patients with compensated patients from another center. RESULTS: LS was the best single noninvasive variable for identifying patients with CSPH (area under the receiver operating characteristic, 0.883; 95% confidence interval [CI], 0.824 -0.943; P Ͻ .0001). The area under the receiver operating characteristic value increased when LS was combined with platelet count and spleen size, either as LSPS (0.918; 95% CI, 0.872Ϫ0.965; P Ͻ .0001) or PH risk score (0.935; 95% CI, 0.893-0.977; P Ͻ .0001). More than 80% of patients were accurately classified using LSPS and PH risk score. Analyses of the varices risk score and LSPS were superior to all other noninvasive tests for identifying patients with EVs (area under the receiver operating characteristic, 0.909; 95% CI, 0.841Ϫ0.954 and 0.882; 95% CI, 0.810 -0.935, respectively); they correctly classified 85% of patients in the training set and 75% in the validation set. CONCLUSIONS: Combined data on LS, spleen diameter, and platelet count can be used to identify patients with compensated cirrhosis most likely to have CSPH and EV.

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Section: Discussionmentioning

confidence: 99%

Elastography, Spleen Size, and Platelet Count Identify Portal Hypertension in Patients With Compensated Cirrhosis

et al. 2013

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“…However, it should be emphasized that most of the patients included in the studies concerning HVPG had viral or alcoholic cirrhosis, and evidence regarding other etiologies is limited. In viral cirrhosis, Young's modulus values of > 20 -25 kPa are highly specific for CSPH, and values of > 21 kPa predict the onset of a first clinical decompensation with an accuracy similar to that of HVPG > 10 mmHg [239].…”

Section: Transient Elastographymentioning

confidence: 90%

“…LSM with TE is useful to identify patients with a high likelihood of having clinically significant portal hypertension (HVPG ≥ 10 mmHg) (LoE 2b, GoR B) [238,239]. Strong consensus (15/0/0, 100 %)…”

Section: Recommendation 28mentioning

confidence: 99%

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2017

Ultraschall in Med

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“…Various studies of ESLD conducted in different clinical settings have demonstrated that LSM values correlate with portal pressure (based on hepatic venous portal gradient) and predict clinical events. Consequently, LSM is beginning to be used to identify patients with cirrhosis who are at risk of disease progression [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

“…The importance of the stage of compensated or decompensated liver disease and the dynamic nature of end-stage liver disease have revolutionized our understanding and care of patients with liver cirrhosis [4,5,15,16].The use of less invasive diagnostic methods and their strong correlation with classic, more invasive, and complicated procedures have made a significant contribution to our knowledge [8][9][10][11][17][18][19]. These new data are from very different patient populations, whose liver disease had diverse etiologies and characteristics.…”

Section: Introductionmentioning

confidence: 99%

Transient Elastography for Predicting Liver-Related Events in Cirrhotic HIV-Infected Patients

Montes¹,

Berenguer²,

Jm³

et al. 2017

J AIDS Clin Res

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Aim : We assessed liver stiffness measurement (LSM) for the prediction of mortality and decompensation in HIVinfected patients with compensated liver cirrhosis. Method:A prospective cohort study of HIV-infected patients with confirmed liver cirrhosis from 9 hospitals in Spain. LSM was undertaken for each patient; clinical events were collected prospectively after the baseline visit, and patients were followed until death or the censoring date. We used univariate/multivariate Cox proportional hazard models to evaluate the utility of LSM for predicting the first hepatic decompensation or overall mortality. The sensitivity (SEN), specificity (SPE), positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+) and negative likelihood ratio (LR-) were calculated. The LSM cutoff was selected using ROC curves. Results:We included 102 patients with compensated liver cirrhosis; median [interquartile, (IQR)] follow-up was 36 (21-46) months, median (IQR) CD4+ cell count was 415 cells/μL (307-624) and 94% were receiving antiretroviral therapy. The median (IQR) LSM was 17 kPa (11.7-26). Nineteen events were recorded during follow-up. Multivariate analysis showed that time to hepatic decompensation was associated with CD4+ <200 cells/μL (HR, 26; 95% CI, 1.8-377; p<0.02) and LSM ≥ 25 kPa (HR, 7.2; 95% CI, 1.1-47; p=0.04) and that time to overall mortality was associated with LSM ≥ 25 kPa (HR, 14.3; 95% CI, 1.5-138; p=0.02). The predictive values for decompensation (LSM ≥ 25 kPa) were as follows: SEN, 67%; SPE, 78%; NPV, 96%; PPV, 23%; LR+, 3; LR-, 0.4. The predictive values for overall mortality with this LSM cutoff were as follows: SEN, 86%; SPE, 79%; NPV, 99%; PPV, 23%; LR+, 4; LR-, 0.2. Conclusion:Our data suggest that LSM is an accurate method for the prediction of mortality and decompensation in HIV-infected patients with liver cirrhosis.

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Liver stiffness accurately predicts portal hypertension related complications in patients with chronic liver disease: A prospective study

Cited by 274 publications

References 31 publications

Elastography, Spleen Size, and Platelet Count Identify Portal Hypertension in Patients With Compensated Cirrhosis

Elastography, Spleen Size, and Platelet Count Identify Portal Hypertension in Patients With Compensated Cirrhosis

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Transient Elastography for Predicting Liver-Related Events in Cirrhotic HIV-Infected Patients

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