Abstract
Liver stiffness is a reliable non-invasive predictor of Hepatic Venous Pressure Gradient (HVPG) above 10 mm Hg. However, it failed to predict higher thresholds of HVPG. Our aim was to investigate whether liver stiffness and selected previously published non-invasive blood biomarkers could predict higher HVPG thresholds in liver transplant candidates without ongoing alcohol use. One hundred and nine liver transplant candidates with liver cirrhosis of various aetiologies underwent direct HVPG measurement, liver stiffness measurement by 2D shear-wave elastography (Aixplorer Multiwave, Supersonic Imagine, France) and assessment of blood HVPG biomarkers (osteopontin, VCAM-1, IL-6, TNF-α, IL-1ra/IL-1F3 and ELF score). The correlation between liver stiffness and HVPG was linear up to 30 mm Hg of HVPG (r = 0.765, p < 0.0001). The regression lines had similar slopes for HVPG values below and above 16 mm Hg (p > 0.05) and the correlation in patients with HVPG <16 mm Hg (r = 0.456, p = 0.01) was similar to patients with HVPG ≥ 16 mm Hg (r = 0.499, p < 0.0001). The correlation was similar in the subgroup patients with alcoholic (r = 0.718, p < 0.0001), NASH (r = 0.740, p = 0.008), cryptogenic (r = 0.648, p = 0,0377), cholestatic and autoimmune (r = 0.706, p < 0.0001) and viral cirrhosis (r = 0.756, p < 0.0001). Liver stiffness distinguished patients with HVPG above 16, and 20 mm Hg with AUROCs 0.90243, and 0.86824, sensitivity 0.7656, and 0.7027, and specificity 0.9333, and 0.8750. All studied blood biomarkers correlated better with liver stiffness than with HVPG and their AUROCs did not exceed 0.8 at both HVPG thresholds. Therefore, a composite predictor superior to liver stiffness could not be established. We conclude that liver stiffness is a clinically reliable predictor of higher HVPG thresholds in non-drinking subjects with advanced liver cirrhosis.
Highlights
Portal hypertension (PH) is the main complication of liver cirrhosis contributing to the development of its life-threatening complications
Ten patients were subsequently excluded from further evaluation: 7 patients for inability to perform representative liver stiffness (LS) measurement in 3 region of interest (ROI), 2 patients for pulmonary hypertension diagnosed by echocardiography and 1 patient who owned up to excessive alcohol consumption
The patients were divided into two groups according to the stage of liver disease based on the Child-Pugh classification: group Child-Pugh score (CPS)-A including patients with Child-Pugh class A (30/109, 27.5%) and group CPS-B/C including patients with ChildPugh class B or C (79/109, 72.5%)
Summary
Portal hypertension (PH) is the main complication of liver cirrhosis contributing to the development of its life-threatening complications. Hepatic venous pressure gradient (HVPG) represents the reference standard for evaluation of the presence and severity of PH in patients with cirrhosis [1]. HVPG is presumably the most often validated tool for assessing prognosis in patients with liver cirrhosis. HVPG higher than 10 mm Hg is considered clinically significant portal hypertension (CSPH) [2]. Patients with CSPH are at risk of oesophageal varices [3,4,5], develop ascites and cirrhosis decompensation [6]. HVPG measurement by hepatic vein catheterization is an invasive procedure and there is a need for an easy and accurate non-invasive method
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