engleski

Evaluation of the newly proposed criteria for clinically significant portal hypertension using platelets and transient elastography

Background and aims: New non-invasive criteria for diagnosing clinically significant portal hypertension (CSPH) have been proposed recently (Pons M. et al. Am Journal Gastroenterol 2020). We aimed to evaluate performance of the proposed criteria in a cohort of patients with compensated chronic liver disease. Methods: We evaluated diagnostic performance of liver stiffness measurement (LSM) by transient elastography and Platelet count (Plt) for CSPH in a cohort of patients with available results of hepatic venous pressure gradient (HVPG) measurements and liver biopsy performed due to suspicion of compensated advanced chronic liver disease (cACLD). Newly proposed non-invasive criteria evaluated here were: LSM≥25 kPa for ruling-in, and Plt≥150 + LSM≤15 kPa for ruling-out CSPH. Only patients >18 years of age, who gave informed consent were included, whereas those with conditions known to affect results of LSM (ALT>5x ULN, liver congestion, extrahepatic biliary obstruction, infiltrative liver neoplasms) were not. Presence of cACLD was confirmed on liver biopsy in patients with bridging fibrosis or cirrhosis. Results: The cohort included 76 patients [78.9% men, median age 62 (34–76) years, 30% obese, mostly suffering from alcoholic (36.8%) or non-alcoholic fatty liver (30.3%) disease], 61 (80.3%) of whom had cACLD, 40 (52.6%) had HVPG ≥10 mmHg (CSPH) and 43 (56.6%) had Plt ≥150. LSM≥25 kPa had 88.9% (95% CI 73.9– 96.9) specificity to rule-in, whereas Plt≥150 + LSM≤15 kPa had 100% (95% CI 73.5–100) sensitivity to rule-out CSPH. By these criteria it was possible to classify correctly 49/76 (64.5%) patients for the presence of CSPH. With increasing BMI, at any given value of Plt, higher LSM was needed for a certain probability of having CSPH. Conclusion: By using these simple new non-invasive criteria almost 65% of patients could be classified correctly for the presence of CSPH. This might facilitate early recognition of CSPH among patients with cACLD and timely introduction of non-selective beta blockers considering the results from PREDESCI trial.

portal hypertension ; platelets ; transient elastography

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