Liver Stiffness Measurement in the Prediction of Clinical Significant Portal Hypertension and Related Complications

Abstract

Hepatic cirrhosis is the end stage of chronic liver disease and leads to portal hypertension (PH) resulting in disease progression manifested with esophageal varices (EV) formation/bleeding, ascites formation and porto-systemic encephalopathy. The detection, prevention and management of portal hypertension and its complication are important for patient with cirrhosis. Hepatic venous pressure gradient (HVPG) has been the standard reference in portal pressure measurement and good predictor of prognosis and therapeutic effects for patients with PH. However, HVPG measurement is an invasive procedure requiring adequate equipment and needing a certain degree of expertise. Liver stiffness (LS) measured with transient elastography is a non-invasive method and in good correlation with portal pressure assessing with HVPG. Although there is also correlation between LS and presence of EV or high-risk EV, it was not as good as that for clinical significant PH. Most studies have demonstrated LS is useful in the prediction of PHT and its complication for patients with hepatic cirrhosis or advanced fibrosis. Clinically significant PH is >90% likely in patients with LS >20-25kPa. A proposed algorithm using LS, platelet count and abdominal sonography provided a useful strategy to detect early PHT. LS-based score incorporating LS, spleen size and platelet count demonstrated to be useful in identifying patients with clinical significant PHT or EV. Braveno VI consensus recommended avoiding screening scope for those patients with LS<20 kPa and platelet count >150000/mm3. Although useful in the EV prediction, LS measurement is not a replacement of scope in the diagnosis of varices for patients with hepatic cirrhosis.