Non-invasive model predicting clinically-significant portal hypertension in patients with advanced fibrosis

• Published in: Journal of gastroenterology and hepatology Vol. 24; no. 7; pp. 1289 - 1293
• Main Authors: Park, Seung Ha, Park, Tae Eun, Kim, Young Mook, Kim, Sung Jung, Baik, Gwang Ho, Kim, Jin Bong, Kim, Dong Joon
• Format: Journal Article
• Language: English
• Published: Melbourne, Australia Blackwell Publishing Asia 01.07.2009; Wiley-Blackwell
• Subjects: Adolescent; Adult; Aged; Bilirubin - blood; Biological and medical sciences; Biomarkers - blood; Biopsy; Disease Progression; Endoscopy, Gastrointestinal; Esophageal and Gastric Varices - blood; Esophageal and Gastric Varices - diagnosis; Esophageal and Gastric Varices - etiology; Esophageal and Gastric Varices - physiopathology; esophageal varices; Female; Gastroenterology. Liver. Pancreas. Abdomen; hepatic venous pressure gradient; Humans; Hypertension, Portal - blood; Hypertension, Portal - diagnosis; Hypertension, Portal - etiology; Hypertension, Portal - physiopathology; Liver Cirrhosis - blood; Liver Cirrhosis - complications; Liver Cirrhosis - diagnosis; Liver Cirrhosis - physiopathology; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Models, Biological; Other diseases. Semiology; Platelet Count; portal hypertension; Predictive Value of Tests; Risk Assessment; Risk Factors; ROC Curve; Sensitivity and Specificity; Venous Pressure; Young Adult; Human; hepatic venous pressure gradient; Portal circulation disease; Liver; Esophageal varices; Cardiovascular disease; Pressure gradient; Vascular disease; Fibrosis; Gastroenterology; Portal hypertension; Digestive diseases; Models; Venous pressure
• DOI: 10.1111/j.1440-1746.2009.05904.x
• ISSN: 0815-9319

Background and Aims:  Hepatic venous pressure gradient (HVPG) has been established as a predictor for the development of varices, clinical decompensation and death. In the present study, the primary objectives were to determine the diagnostic accuracy of the model developed by using readily‐available data in predicting the presence of significant portal hypertension and esophageal varices. Methods:  This study included a total of 61 consecutive treatment‐naive patients with advanced fibrosis (METAVIR F3, F4), established by liver biopsy. All patients underwent subsequent HVPG measurement and upper gastrointestinal endoscopy within 1 week of liver biopsy. Results:  Seventeen patients (F3, 2/26; F4, 15/35) had clinically‐significant portal hypertension (HVPG ≥ 10 mmHg). The Risk Score for predicting significant portal hypertension was 14.2 − 7.1 × log10 (platelet [109/L]) + 4.2 × log10 (bilirubin [mg/dL]). The area under the receiver–operator curve (AUC) curve was 0.91 (95% confidence interval [CI], 0.84–0.98). The optimized cut‐off value (Risk Score = −1.0) offered a sensitivity of 88% (95% CI, 62–98%) and a specificity of 86% (95% CI, 72–94%). The AUC of the Risk Score in predicting varices was 0.82 (95% CI, 0.67–0.98). The cut‐off had a sensitivity of 82% (95% CI, 48–97%) and a specificity of 76% (95% CI, 62–86%). Conclusion:  A predictive model that uses readily‐available laboratory results may reliably identify advanced fibrosis patients with clinically‐significant portal hypertension as well as esophageal varices. However, before accepted, the results of the current study certainly should be validated in larger prospective cohorts.