Transient elastography accurately predicts presence of significant portal hypertension in patients with chronic liver disease

Bureau, C.; Métivier, Sophie; Péron, Jean Marie; Sèlves, Janick; Robic, Marie Angèle; Gourraud, Pierre-Antoine; Rouquet, O.; DuPuis, E. Melanie; Alric, Laurent; Vinel, Jean–Pierre

doi:10.1111/j.1365-2036.2008.03701.x

Cited by 338 publications

(293 citation statements)

References 30 publications

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“…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].…”

Section: Monitoring Of Disease Progressionmentioning

confidence: 94%

Non-invasive assessment of liver fibrosis in chronic hepatitis C

Castéra

2011

Hepatol Int

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Section: Monitoring Of Disease Progressionmentioning

confidence: 94%

Non-invasive assessment of liver fibrosis in chronic hepatitis C

Castéra

2011

Hepatol Int

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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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“…[13][14][15] Besides, LS provides additional information in the setting of ESLD. Thus, studies conducted in HCVmonoinfected [16][17][18][19] and HIV/HCV-coinfected subjects 20 have demonstrated that the presence of esophageal varices can be predicted by LS. Moreover, LS correlates with portal hypertension, the hallmark of the evolution of chronic liver disease, in patients with HCV-related cirrhosis, 21,22 including those infected by HIV.…”

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confidence: 99%

Liver stiffness predicts clinical outcome in human immunodeficiency virus/hepatitis C virus-coinfected patients with compensated liver cirrhosis

Merchante

Rivero‐Juárez

Téllez³

et al. 2012

Hepatology

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on behalf of the Grupo Andaluz para el Estudio de las Hepatitis Víricas (HEPAVIR) de la Sociedad Andaluza de Enfermedades Infecciosas (SAEI)Our aim was to assess the predictive value of liver stiffness (LS), measured by transient elastography (TE), for clinical outcome in human immunodeficiency virus / hepatitis C virus (HIV/HCV)-coinfected patients with compensated liver cirrhosis. This was a prospective cohort study of 239 consecutive HIV/HCV-coinfected patients with a new diagnosis of cirrhosis, done by TE, and no previous decompensation of liver disease. The time from diagnosis to the first liver decompensation and death from liver disease, as well as the predictors of these outcomes, were evaluated. After a median (Q1-Q3) follow-up of 20 (9-34) months, 31 (13%, 95% confidence interval [CI]: 9%-17%) patients developed a decompensation. The incidence of decompensation was 6.7 cases per 100 person-years (95% CI, 4.7-9-6). Fourteen (8%) out of 181 patients with a baseline LS < 40 kPa developed a decompensation versus 17 (29%) out of 58 with LS 40 kPa (P 5 0.001). Factors independently associated with decompensation were Child-Turcotte-Pugh (CTP) class B versus A (hazard ratio [HR] 7.7; 95% CI 3.3-18.5; P < 0.0001), log-plasma HCV RNA load (HR 2.1; 95% CI 1.2-3.6; P 5 0.01), hepatitis B virus coinfection (HR, 10.3; 95% CI, 2.1-50.4; P 5 0.004) and baseline LS (HR 1.03; 95% CI 1.01-1.05; P 5 0.02). Fifteen (6%, 95% CI: 3.5%-9.9%) patients died, 10 of them due to liver disease, and one underwent liver transplantation. CTP class B (HR 16.5; 95% CI 3.4-68.2; P < 0.0001) and previous exposure to HCV therapy (HR 7.4; 95% CI 1.7-32.4, P 5 0.007) were independently associated with liver-related death; baseline LS (HR 1.03; 95% CI 0.98-1.07; P 5 0.08) was of borderline significance. Conclusion: LS predicts the development of hepatic decompensations and liver-related mortality in HIV/HCV-coinfection with compensated cirrhosis and provides additional prognostic information to that provided by the CTP score. (HEPATOLOGY 2012;56:228-238)

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Transient elastography accurately predicts presence of significant portal hypertension in patients with chronic liver disease

Abstract: SUMMARY BackgroundHepatic venous pressure gradient (HVPG) is a prognostic marker in patients with cirrhosis. Transient elastography measures liver stiffness (LS).

Cited by 338 publications

References 30 publications

Non-invasive assessment of liver fibrosis in chronic hepatitis C

Non-invasive assessment of liver fibrosis in chronic hepatitis C

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

Liver stiffness predicts clinical outcome in human immunodeficiency virus/hepatitis C virus-coinfected patients with compensated liver cirrhosis

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