Liver Stiffness-Based Model Predicts Hepatic Venous Pressure Gradient in Patients Undergoing Hepatectomy and Liver Transplantation

Abstract

Background: Invasive hepatic venous pressure gradient (HVPG) measurement is the gold standard test to assess portal hypertension. The aim was to develop a model predictive of clinically significant portal hypertension (HVPG≥10mmHg) using pre-operative noninvasive makers. Methods: 161 patients [66% men, median age of 63 years] who have been planned for liver resection/transplantation were enrolled prospectively and preoperative liver stiffness measurement (LSM), liver function test, and intraoperative HVPG were performed. Results: Median LSM, and HVPG were 9.5kPa, and 5mmHg respectively. No underlying liver disease (F0/1), chronic liver disease (F2/3), and cirrhosis (F4) were found in 32.9%, 32.9% and 34.2% patients respectively. The study cohort was randomly divided into training [n=106] and validation [n=55] sets. Independent predictors of HVPG≥10mmHg in the training set, LSM [p< 0.01, OR=1.1], total bilirubin [p=0.04, OR=0.9], alkaline phosphatase [p=0.02, OR=1], and international normalized ratio [p< 0.01, OR=41.4], were used to develop a probability score model called HVPG10score. Area under receiver operating curve in the training and internal validation sets were 0.91 [95%CI:0.83-0.98] and 0.93 [95%CI:0.86-0.99] respectively with a cutoff of 0.15. HVPG10score was calculated by multiplying the probability by 100. In the overall cohort, HVPG10score of 15 would predict the individual risk of HVPG≥10mmHg with 83% accuracy, 90% sensitivity, 81% specificity and 96% negative predictive value. Conclusions: HVPG10score is an easy-to-use noninvasive continuous scale tool to predict HVPG≥10mmHg. A score < 15 would accurately rule out the need for esophageal varices screening and risk of decompensation in >95% chronic liver disease patients.