Assessment of portal hypertension by transient elastography in patients with compensated cirrhosis and potentially resectable liver tumors

Prognostic markers of compensated cirrhosis should mainly investigate factors involved with progression to decompensation because death in cirrhosis is related with decompensation. Portal hypertension plays a crucial role in the pathophysiology of most complications of cirrhosis. Accordingly, HVPGmonitoring has strong prognostic value. An HVPG ≥ 10 mmHg determines a significantly higher risk of developing decompensation. Esophageal varices also can develop when the HVPG is ≥ 10 mmHg, although an HVPG ≥ 12 mmHg is required for variceal bleeding to occur. Monitoring the changes induced by the treatment of portal hypertension on HVPG, provides strong prognostic information. In compensated cirrhosis hemodynamic response is appropriate when the HVPG decreased to <10 mmHg or by > 10% from baseline, because the incidence of complications such as bleeding or ascites significantly decrease when these targets are achieved. Whether serum markers, such as the FibroTest, they, may be valuable to predict decompensation should be established. Transient Elastography is a promising technique that has shown an excellent accuracy to detect severe portal hypertension. However, whether it can adequately determine clinically significant portal hypertension, and risk of developing varices and decompensation, should be established. Magnetic Resonance Elastography is also promising.

Download Full-text

SVR12 Higher than 97% in GT3 Cirrhotic Patients with Evidence of Portal Hypertension Treated with SOF/VEL without Ribavirin: A Nation-Wide Cohort Study

Cells ◽

10.3390/cells8040313 ◽

2019 ◽

Vol 8 (4) ◽

pp. 313 ◽

Cited By ~ 9

Author(s):

Alessandra Mangia ◽

Giovanni Cenderello ◽

Massimiliano Copetti ◽

Gabriella Verucchi ◽

Valeria Piazzolla ◽

...

Keyword(s):

Clinical Trials ◽

Portal Hypertension ◽

Transient Elastography ◽

Real Life ◽

Genotype 3 ◽

Compensated Cirrhosis ◽

Advanced Cirrhosis ◽

Real Life Data ◽

Single Tablet Regimen ◽

Cirrhotic Patients

In clinical trials, a sofosbuvir/velpatasvir (SOF/VEL) pangenotypic single-tablet regimen was associated with high sustained virological response (SVR) rates at 12 weeks (SVR12) after the end of treatment, regardless of genotype and fibrosis stage. No real-life data on genotype 3 (GT3) cirrhotic patients with portal hypertension are available. The aim of this study was to assess the effectiveness of SOF/VEL in GT3 cirrhotics with portal hypertension. Patients with GT3 and advanced cirrhosis were treated for 12 weeks with SOF/VEL without ribavirin at five different centers in Italy from June 2017 to August 2018 and their SVR12 was assessed. Of the 227 GT3 cirrhotics evaluated, 205 met the inclusion criteria and 111 had transient elastography results ≥20 KPa. SVR12 was 97.6% (95% CI 94.4–98.9), rates were 99.1% (95% CI 95.7–99.8) in patients with ≥20 KPa and 95.8% (95% CI 89.5–98.3) in those with <20 KPa (p = 0.18). Analyzed by presence of esophageal varices, the SVR12 rates were 98.4% (95% CI 91.4–99.7) and 97.1% (95% CI 92.9–98.9) in patients without and with varices, respectively (p = 1.0). In real life, SOF/VEL GT3 cirrhotic patients with evidence of portal hypertension can achieve SVR12 levels comparable to those of patients without portal hypertension. These SVR12 rates are similar to what is reported in compensated cirrhosis treated within clinical trials.

Download Full-text

Clinical Evaluation and Prognosis

Digestive Diseases ◽

10.1159/000374100 ◽

2015 ◽

Vol 33 (4) ◽

pp. 515-523 ◽

Cited By ~ 5

Author(s):

Virginia Hernández-Gea ◽

Annalisa Berzigotti

Keyword(s):

Portal Hypertension ◽

Variceal Bleeding ◽

Transient Elastography ◽

Venous Pressure ◽

Liver Stiffness ◽

Secondary Prophylaxis ◽

Decompensated Cirrhosis ◽

Compensated Cirrhosis ◽

Biological Variables ◽

Obesity And Diabetes

Background: Liver cirrhosis is no longer considered a homogeneous disease, with two different phases now identified: ‘compensated' and ‘decompensated' cirrhosis, in which complications of cirrhosis characterize the latter. Within each phase, different stages and predictors should be recognized in order to correctly stratify the prognosis and individualize possible therapeutic options. Key Messages: In compensated cirrhosis the presence of clinically significant portal hypertension [CSPH = hepatic venous pressure gradient (HVPG) ≥10 mm Hg] constitutes the most important independent predictor of several relevant clinical endpoints (formation of esophageal varices; first clinical decompensation). An optimal HVPG response to medical therapy of portal hypertension (HVPG reduction <12 mm Hg or ≥20% vs. the pretreatment value, responders) has been consistently linked to a decrease in the risk of variceal bleeding both in primary and secondary prophylaxis, and to a decrease in the risk of presenting other clinical decompensating events. Furthermore, in patients undergoing secondary prophylaxis of variceal bleeding, being an HVPG responder is associated with an improved survival. HVPG also maintains an independent prognostic value in patients with decompensated cirrhosis. Noninvasive alternatives to HVPG for the prediction of CSPH have been investigated; liver stiffness by transient elastography and the combination of liver stiffness, spleen size by ultrasound and platelet count are currently the best methods to noninvasively diagnose CSPH, with an accuracy of about 90%. Additional factors modulate prognosis in cirrhosis. Liver function (albumin, bilirubin, INR) is independently associated with prognosis both in compensated and decompensated cirrhosis, and in the latter phase renal function also plays a central role. Among clinical cofactors, obesity and diabetes are emerging as variables increasing the risk of progression to decompensation and death in cirrhosis. Conclusions: Prognostic stratification in patients with cirrhosis should take into account a complex interplay of several clinical, hemodynamic and biological variables. The present review summarizes the existing evidence regarding prognostic factors in cirrhosis, with particular emphasis on compensated cirrhosis.

Download Full-text

Faculty Opinions recommendation of Elastography, spleen size, and platelet count identify portal hypertension in patients with compensated cirrhosis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717975913.793470332 ◽

2013 ◽

Author(s):

Stephen Stewart ◽

Zita Galvin

Keyword(s):

Platelet Count ◽

Portal Hypertension ◽

Spleen Size ◽

Compensated Cirrhosis

Download Full-text

Non-invasive methods in the assessment of portal hypertension severity

Gastroenterologie a hepatologie ◽

10.48095/ccgh2021125 ◽

2021 ◽

Vol 75 (2) ◽

pp. 125-133

Author(s):

Soňa Franková ◽

Jan Šperl

Keyword(s):

Portal Hypertension ◽

Liver Fibrosis ◽

Shear Wave ◽

Transient Elastography ◽

Venous Pressure ◽

Liver Stiffness ◽

Invasive Technique ◽

Hepatic Veins ◽

Oesophageal Varices ◽

Non Invasive

Portal hypertension represents a wide spectrum of complications of chronic liver diseases and may present by ascites, oesophageal varices, splenomegaly, hypersplenism, hepatorenal and hepatopulmonary syndrome or portopulmonary hypertension. Portal hypertension and its severity predicts the patient‘s prognosis: as an invasive technique, the portosystemic gradient (HPVG – hepatic venous pressure gradient) measurement by hepatic veins catheterisation has remained the gold standard of its assessment. A reliable, non-invasive method to assess the severity of portal hypertension is of paramount importance; the patients with clinically significant portal hypertension have a high risk of variceal bleeding and higher mortality. Recently, non-invasive methods enabling the assessment of liver stiffness have been introduced into clinical practice in hepatology. Not only may these methods substitute for liver biopsy, but they may also be used to assess the degree of liver fibrosis and predict the severity of portal hypertension. Nowadays, we can use the quantitative elastography (transient elastography, point shear-wave elastrography, 2D-shear-wave elastography) or magnetic resonance imaging. We may also assess the severity of portal hypertension based on the non-invasive markers of liver fibrosis (i.e. ELF test) or estimate clinically signifi cant portal hypertension using composite scores (LSPS – liver spleen stiff ness score), based on liver stiffness value, spleen diameter and platelet count. Spleen stiffness measurement is a new method that needs further prospective studies. The review describes current possibilities of the non-invasive assessment of portal hypertension and its severity.

Download Full-text

Noninvasive Evaluation of Portal Hypertension Using a Supervised Learning Technique

Journal of Healthcare Engineering ◽

10.1155/2017/6183714 ◽

2017 ◽

Vol 2017 ◽

pp. 1-10 ◽

Cited By ~ 4

Author(s):

Mindaugas Marozas ◽

Romanas Zykus ◽

Andrius Sakalauskas ◽

Limas Kupčinskas ◽

Arūnas Lukoševičius

Keyword(s):

Portal Hypertension ◽

Supervised Learning ◽

Evaluation Method ◽

Clinical Laboratory ◽

Transient Elastography ◽

Venous Pressure ◽

Noninvasive Evaluation ◽

Noninvasive Methods ◽

Supervised Learning Algorithms ◽

Clinically Significant

Portal hypertension (PHT) is a key event in the evolution of different chronic liver diseases and leads to the morbidity and mortality of patients. The traditional reliable PHT evaluation method is a hepatic venous pressure gradient (HVPG) measurement, which is invasive and not always available or acceptable to patients. The HVPG measurement is relatively expensive and depends on the experience of the physician. There are many potential noninvasive methods to predict PHT, of which liver transient elastography is determined to be the most accurate; however, even transient elastography lacks the accuracy to be a perfect noninvasive diagnostic method of PHT. In this research, we are focusing on noninvasive PHT assessment methods that rely on selected best-supervised learning algorithms which use a wide set of noninvasively obtained data, including demographical, clinical, laboratory, instrumental, and transient elastography measurements. In order to build the best performing classification meta-algorithm, a set of 21 classification algorithms have been tested. The problem was expanded by selecting the best performing clinical attributes using algorithm-specific filtering methods that give the lowest error rate to predict clinically significant PHT. The suggested meta-algorithm objectively outperforms other methods found in literature and can be a good substitute for invasive PHT evaluation methods.

Download Full-text

“SPLEEN STIFFNESS MEASUREMENT IN LIVER CIRRHOSIS PATIENTS FOR NONINVASIVE ASSESSMENT OF ESOPHAGEAL VARICES USING FIBROSCAN”

10.36106/ijsr/8609582 ◽

2020 ◽

pp. 1-2

Author(s):

Revathy Marimuthu Shanmugam ◽

Vinay C ◽

Sathya Gopalasamy ◽

Chitra Shanmugam

Keyword(s):

Liver Cirrhosis ◽

Portal Hypertension ◽

Esophageal Varix ◽

Esophageal Varices ◽

Transient Elastography ◽

Liver Stiffness ◽

Surrogate Marker ◽

Stiffness Measurement ◽

Spleen Stiffness ◽

Cirrhotic Patients

BACKGROUND: Many noninvasive surrogate marker for Portal hypertension or for the presence or grade of esophageal varices were studied..Splenomegaly along with splenic congestion secondary to splenic hyperdynamic circulation is seen secondary to Portal hypertension in cirrhotic patients that can be quantified by elastography. AIM:The aim of this study was to investigate whether spleen stiffness, assessed by TE, useful tool for grading chronic liver diseases and to compare its performance in predicting the presence and size of esophageal varices in liver cirrhosis patients. METHODOLOGY:86 patients with cirrhosis and 80 controls underwent transient elastography of liver and spleen for the assessment of liver stiffness (LSM) and spleen stiffness (SSM) . Upper GI endoscopy done in all Cirrhotic patients. RESULTS: Spleen stiffness showed higher values in liver cirrhosis patients as compared with controls: 58.2 kpa vs14.8 kpa (P < 0.0001) and also found to be significantly higher in cirrhotic patients compared with varices and those without varices (69.01 vs 42.05 kpa, P < 0.0001). Liver stiffness was also found to be higher in cirrhotic patients with varices when compared to patients without varices (38.5vs 21.2 kpa). Using both liver and spleen stiffness measurement we can predicted the presence of esophageal varices correctly. CONCLUSION: Spleen stiffness can be assessed using transient elastography, higher value correlated well with liver cirrhosis and presence of esophageal varices although it couldn’t correlate with grade of Esophageal Varix. Combined assessment of spleen and liver stiffness had better prediction of presence of Esophageal Varix.

Download Full-text