Abstract
BackgroundTo assess correlation between liver or spleen stiffness measurement by transient elastography (TE) and hepatic venous pressure gradient (HVPG) in patients with chronic liver disease as well find optimal and rule in/rule out cut-offs for prognosis of clinically significant (CSPH) and severe (SPH) portal hypertension.MethodsIn this prospective study patients with different chronic liver diseases were included. TE was performed at the same day prior to HVPG measurement. HVPG was measured using catheter tip occlusion technique. Based on HVPG, patients were categorized into groups of CSPH and SPH. Cut-off values were established by applying ROC curve analysis.ResultsThe study included 107 consecutive patients referred for HVPG measurement or transjugular liver biopsy. Successful spleen TE was performed in 99 of the patients. Liver and spleen TE strongly correlated with HVPG, r = 0.75 and r = 0.62, respectively. Accuracy to detect CSPH was 88.7 % for liver stiffness of 17.4 kPa and 77.7 % for spleen stiffness of 47.6 kPa. Accuracy to detect SPH was 83.1 % for liver stiffness of 20.6 kPa and 77.7 % for spleen stiffness of 50.7 kPa. Liver stiffness <11.4 kPa could rule out CSPH with 55.2 % specificity and >21.9 kPa rule in CSPH with 74.4 % sensitivity. Liver stiffness <12.1 kPa could rule out SPH with 50.0 % specificity and >35 kPa rule in SPH with 58.2 % sensitivity.ConclusionsLiver and spleen stiffness correlate with HVPG and could be used to predict CSPH or SPH. Spleen elastography was not superior to liver elastography in predicting portal hypertension.
Highlights
To assess correlation between liver or spleen stiffness measurement by transient elastography (TE) and hepatic venous pressure gradient (HVPG) in patients with chronic liver disease as well find optimal and rule in/rule out cut-offs for prognosis of clinically significant (CSPH) and severe (SPH) portal hypertension
The aim of our study was to assess correlation of liver and spleen stiffness measured by transient elastography (TE) with HVPG in patients with chronic liver disease
Spearman correlation analysis revealed that both liver and spleen elastography correlated with hepatic venous pressure gradient
Summary
To assess correlation between liver or spleen stiffness measurement by transient elastography (TE) and hepatic venous pressure gradient (HVPG) in patients with chronic liver disease as well find optimal and rule in/rule out cut-offs for prognosis of clinically significant (CSPH) and severe (SPH) portal hypertension. Direct measurement of portal hypertension is invasive and rarely used in clinical practice due to potential complications. Liver stiffness could predict portal pressure by measuring physical properties of structural changes emerging in last stages of liver fibrosis; liver elastography could be potentially accurate tool for stiffness assessment. Spleen elastography has been investigated as a tool to reflect dynamic (vascular) component next to structural part of portal hypertension. The aim of our study was to assess correlation of liver and spleen stiffness measured by transient elastography (TE) with HVPG in patients with chronic liver disease. We aimed to find optimal liver and spleen TE values as well as rule in/rule out values in predicting CSPH and SPH
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