The usefulness of non-invasive liver stiffness measurements in predicting clinically significant portal hypertension in cirrhotic patients: Korean data

Abstract

Background/aims: Liver stiffness measurement (LSM) has been proposed as a non-invasive method for estimating the severity of fibrosis and the complications of cirrhosis. Measurement of the hepatic venous pressure gradient (HVPG) is the gold standard for assessing the presence of portal hypertension, but its invasiveness limits its clinical application. In this study we evaluated the relationship between LSM and HVPG, and the predictive value of LSM for clinically significant portal hypertension (CSPH) and severe portal hypertension in cirrhosis.

Methods: LSM was performed with transient elastography in 59 consecutive cirrhotic patients who underwent hemodynamic HVPG investigations. CSPH and severe portal hypertension were defined as HVPG ≥10 and ≥12 mmHg, respectively. Linear regression analysis was performed to evaluate the relationship between LSM and HVPG. Diagnostic values were analyzed based on receiver operating characteristic (ROC) curves.

Results: A strong positive correlation between LSM and HVPG was observed in the overall population (r(2)=0.496, P<0.0001). The area under the ROC curve (AUROC) for the prediction of CSPH (HVPG ≥10 mmHg) was 0.851, and the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for an LSM cutoff value of 21.95 kPa were 82.5%, 73.7%, 86.8%, and 66.7%, respectively. The AUROC at prediction of severe portal hypertension (HVPG ≥12 mmHg) was 0.877, and the sensitivity, specificity, PPV, and NPV at LSM cutoff value of 24.25 kPa were 82.9%, 70.8%, 80.6%, and 73.9%, respectively.

Conclusions: LSM exhibited a significant correlation with HVPG in patients with cirrhosis. LSM could be a non-invasive method for predicting CSPH and severe portal hypertension in Korean patients with liver cirrhosis.

Keywords: Cirrhosis; Liver stiffness measurement; Portal hypertension.

Figure 1

Analysis of the linear regression between the hepatic venous pressure gradient (HVPG) and liver stiffness measurement (LSM). A strong positive correlation between LSM and HVPG was observed in the overall population (r²=0.496, P<0.05) (A) and in the subgroups with HVPG ≥10 mmHg (r²=0.297, P<0.05) (B) and HVPG ≥12 mmHg (r²=0.192, P<0.05) (C).

Figure 2

Receiver operating characteristic (ROC) curves demonstrating the prediction of clinically significant portal hypertension (i.e., HVPG ≥10 mmHg) (A) and severe portal hypertension (i.e., HVPG ≥12 mmHg) (B) with transient elastography in the entire patient population; the corresponding areas under the ROC curves (AUROC) were 0.851 and 0.877, respectively. PPV, positive predictive value; NPV, negative predictive value.