Research ArticleLiver stiffness accurately predicts portal hypertension related complications in patients with chronic liver disease: A prospective study
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.
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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.
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These authors contributed equally to this work.