Elsevier

Journal of Hepatology

Volume 55, Issue 5, November 2011, Pages 1017-1024
Journal of Hepatology

Research Article
Liver stiffness accurately predicts portal hypertension related complications in patients with chronic liver disease: A prospective study

https://doi.org/10.1016/j.jhep.2011.01.051Get rights and content

Background & Aims

The prognosis of patients with chronic liver disease is to a great extent determined by the presence and degree of portal hypertension (PHT). Hepatic venous pressure gradient (HVPG) has been shown to be an accurate prognostic index in patients with cirrhosis. Transient elastography is a non-invasive procedure that assesses liver fibrosis through the measurement of liver stiffness (LS). In several reports, LS was found to be correlated with HVPG. LS could therefore be useful to identify patients with significant PHT. The aim of the present study was to prospectively assess and to compare the prognostic performances of LS and HVPG in patients with chronic liver disease.

Methods

One hundred patients with chronic liver disease underwent LS and HVPG measurements on the same day. Patients were thereafter followed-up for 2 years or until they experienced a complication related to their liver disease.

Results

Within the two-year follow-up, 41 patients developed, at least, one liver disease related complication. The performances of HVPG and LS for predicting the occurrence of these complications were not significantly different: AUROC 0.815 [0.727–0.903] and 0.837 [0.754–0.920], respectively. When considering only complications related to PHT, both methods were found to be similarly accurate: AUROC 0.830 [0.751–0.910] and 0.845 [0.767–0.823], for HVPG and LS, respectively. When patients were divided in two groups according to a LS value below or above 21.1 kPa, actuarial rates of remaining free of any complication at 2 years were 85.4% vs. 29.5%, respectively. When only PHT related complications were considered, these rates were 100% vs. 47.5%, respectively. The performances of LS and HVPG were also similar in the subgroup of 65 patients with cirrhosis.

Conclusions

LS proved as effective as HVPG in predicting clinical decompensation and PHT related complications in patients with chronic liver disease. Therefore, LS could be a valuable clinical tool to avoid invasive procedures.

Introduction

In patients with cirrhosis, disease complications are mainly related to portal hypertension (PHT), which in turn correlates with hepatic venous pressure gradient (HVPG) [1]. The complications of cirrhosis are usually observed when HVPG is higher than 10 mmHg [2] and, accordingly, HVPG has been found to be an excellent predictor of clinical decompensation [3]. HVPG measurement is an invasive procedure, which requires hepatic vein catheterization. This procedure is technically difficult and needs specialized settings and training [4]. Until now, non-invasive approaches have proved inaccurate for the early prediction of clinical decompensation in cirrhotic patients [5], [6].

Non-invasive methods for measuring liver fibrosis have been recently developed. Transient elastography assesses liver fibrosis by measuring liver stiffness (LS) [7], [8]. Several reports showed that, in patients with chronic hepatic diseases, LS increases as fibrosis progresses [7], [9], [10]. Moreover, LS was found to be correlated with HVPG in several studies and, therefore, was able to detect the presence of significant PHT [11], [12], [13], [14], [15]. The aim of the present study was to assess and compare LS and HVPG performances in predicting the occurrence of complications in patients with chronic liver disease.

Section snippets

Patients

Between November 15, 2005 and October 15, 2006, LS was measured by Fibroscan® (FS) in 150 patients who underwent a transjugular liver biopsy with hemodynamic measurements (HVPG). This was done regardless of the etiology of liver abnormalities or the stage of liver disease. Of the 150 patients, 8 refused to be followed-up, 24 were followed-up in other hospitals, and 18 were excluded due to hematologic diseases or due to the presence of clinical decompensation at inclusion. Therefore, there

Patient characteristics

Main clinical and biochemical characteristics of the 100 patients are presented in Table 1. Mean follow-up period was 491 days. HVPG was higher than 10 mmHg in 51 patients. Cirrhosis was diagnosed in 65 patients, whose mean Child–Pugh score and MELD score were 7.6 [5–11] and 12.2 [5–15], respectively. In the subgroup of cirrhotic patients, no varices were found in 18 patients (27.5%). Esophageal varices were grade 1 in 18 patients (27.7%), grade 2 in 25 patients (39%), and grade 3 in 4 patients

Discussion

The present study shows a strong relationship between LS and the risk of decompensation in patients with chronic liver disease, regardless of the presence of cirrhosis.

To the best of our knowledge this is the first study that prospectively assessed the performance of LS for predicting clinical complications and that compared it with HVPG measurement. HVPG is a well established index in different clinical settings for patients with cirrhosis [2], [3]. However, the only available method to assess

Conflict of interest

The authors who have taken part in this study declared that they do not have anything to disclose regarding funding or conflict of interest with respect to this manuscript.

References (30)

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These authors contributed equally to this work.

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