Liver stiffness measurement predicts severe portal hypertension in patients with HCV-related cirrhosis

Abstract

Measurement of hepatic venous pressure gradient (HVPG) is a standard method for the assessment of portal pressure and correlates with the occurrence of its complications. Liver stiffness measurement (LSM) has been proposed as a noninvasive technique for the prediction of the complications of cirrhosis. In this study, we evaluated the ability of LSM to predict severe portal hypertension compared with that of HVPG in 61 consecutive patients with HCV-related chronic liver disease. A strong relationship between LSM and HVPG measurements was found in the overall population (r ‫؍‬ 0.81, P < 0.0001). However, although the correlation was excellent for HVPG values less than 10 or 12 mm Hg (r ‫؍‬ 0.81, P ‫؍‬ 0.0003 and r ‫؍‬ 0.91, P < 0.0001, respectively), linear regression analysis was not optimal for HVPG values >10 mm Hg (r 2 ‫؍‬ 0.35, P < 0.0001) or >12 mm Hg (r 2 ‫؍‬ 0.17, P ‫؍‬ 0.02). The AUROC for the prediction of HVPG >10 and >12 mm Hg were 0.99 and 0.92, respectively and at LSM cutoff values of 13.6 kPa and 17.6 kPa, sensitivity was 97% and 94%, respectively. In patients with cirrhosis, LSM positively correlated with the presence of esophageal varices (P ‫؍‬ 0.002), although no correlation between LSM and esophageal varices size was detected. The area under the ROC for the prediction of EV was 0.76 and at a LSM cutoff value of 17.6 kPa sensitivity was 90%. Conclusion: LSM represents a non-invasive tool for the identification of chronic liver disease patients with clinically significant or severe portal hypertension and could be employed for screening patients to be subjected to standard investigations including upper GI endoscopy and hemodynamic studies.

Liver fibrosis: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL)

“…In another study, FibroTest was found to correlate with the presence and degree of portal hypertension. A strong relationship between liver stiffness measurement and HVPG measurements was found in the study [39]. HVPG measurement is done after overnight fasting, under conscious sedation, and vital sign monitoring (including heart rate, arterial blood pressures, digital oxygen saturation, and electrocardiogram) under local anesthesia and aseptic conditions [40,41].…”

Non-invasive assessment of liver fibrosis in chronic hepatitis C

“…Although retrospective and conducted in a single centre, this study provided the first ''proof of concept'' that liver stiffness values may have prognostic value in a context of cirrhosis. In addition, several studies [78,79] have shown a correlation between liver stiffness values and portal hypertension diagnosed by means of hepatic venous pressure gradient (HVPG) measurement, the gold standard for the diagnosis and staging of portal hypertension and a reliable predictor of clinical decompensation [80]. A correlation between liver stiffness values and the presence of esophageal varices has also been reported [79,[81][82][83][84].…”

“…In addition, several studies [78,79] have shown a correlation between liver stiffness values and portal hypertension diagnosed by means of hepatic venous pressure gradient (HVPG) measurement, the gold standard for the diagnosis and staging of portal hypertension and a reliable predictor of clinical decompensation [80]. A correlation between liver stiffness values and the presence of esophageal varices has also been reported [79,[81][82][83][84]. However, liver stiffness measurement (LSM) cannot yet confidently predict the presence of esophageal varices in clinical practice and thus avoid the need for upper GI endoscopic screening of cirrhotic patients [85].…”

Asian-Pacific Association for the Study of the Liver (APASL) consensus guidelines on invasive and non-invasive assessment of hepatic fibrosis: a 2016 update

“…HVPG (AUROC 0.85; sensitivity: 80 %; specificity: 77 %) was superior to serologic biomarkers in predicting advanced fibrosis in chronic viral hepatitis [173]. In post-liver transplant patients, liver stiffness measurement (LSM) correlated with HVPG measurements, and the correlation between LSM and HVPG was excellent in patients with HVPG values \10-12 mmHg [174]. The AUROC curve for predicting HVPG 10-12 mmHg ranges from 0.76 to 0.99 with a cutoff of 13.6-34.9 kPa [174,175].…”

“…In post-liver transplant patients, liver stiffness measurement (LSM) correlated with HVPG measurements, and the correlation between LSM and HVPG was excellent in patients with HVPG values \10-12 mmHg [174]. The AUROC curve for predicting HVPG 10-12 mmHg ranges from 0.76 to 0.99 with a cutoff of 13.6-34.9 kPa [174,175]. The correlation between portal pressure and LSM decreases when HVPG values exceed 10-12 mmHg.…”