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Validation of the New Diagnostic Criteria for Clinically Significant Portal Hypertension by Platelets and Elastography

Background and Aims We aimed to validate newly proposed noninvasive criteria for diagnosing clinically signifcant portal hypertension (CSPH) using liver stifness measurements (LSM) by transient elastography (TE) and platelet count. Methods Diagnostic performance of these new criteria for CSPH (LSM≥25 kPa to rule in and Plt≥150× 109 /L+LSM≤1 5 kPa to rule out CSPH) were retrospectively tested in an independent cohort of consecutive patients who underwent hepatic venous pressure gradient (HVPG) measurements and liver biopsy due to suspicion of compensated advanced chronic liver disease. Suspicion of cACLD was based on LSM≥10 kPa by TE or results of liver imaging, without overt signs of CSPH. Patients with conditions known to afect results of LSM (ALT>5×ULN, liver congestion, extrahepatic biliary obstruction, infltrative liver neoplasms) were excluded. Results Seventy six (76) patients were included: 78.9% males, mean age 62 years, 36.8% sufered from alcoholic, 30.3% nonalcoholic fatty liver disease, 14.5% chronic viral hepatitis, 30.3% were obese, 52.6% had HVPG≥10 mmHg, 56.6% had platelet count≥150× 109 /L. LSM≥25 kPa had 88.9% specifcity (95% CI 73.9– 96.9) to rule in, whereas Plt≥150+LSM≤15 kPa had 100% sensitivity (95% CI 91.1–100) to rule out CSPH. Conclusion By using these simple noninvasive criteria 49/76 (64.5%) patients could be classifed correctly for the presence/ absence of CSPH, thus obviating the need for HVPG measurements

Chronic liver disease ; Liver cirrhosis ; Portal hypertension ; Elastography

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