Noninvasive Diagnostics for Portal Hypertension: A Comprehensive Review

2020 ◽  
Vol 40 (03) ◽  
pp. 240-255 ◽  
Author(s):  
Mattias Mandorfer ◽  
Virginia Hernández-Gea ◽  
Juan Carlos García-Pagán ◽  
Thomas Reiberger
Keyword(s):  
Portal Hypertension ◽  
Beta Blockers ◽  
Venous Pressure ◽  
Target Population ◽  
Diagnostic Value ◽  
Clinical Settings ◽  
Hepatic Decompensation ◽  
Noninvasive Methods ◽  
Noninvasive Diagnostics ◽  
Clinically Significant

AbstractNoninvasive diagnostics for portal hypertension include imaging and functional tests, as well as blood-based biomarkers, and capture different features of the portal hypertensive syndrome. Definitive conclusions regarding their clinical utility require assessment of their diagnostic value in specific clinical settings (i.e., diagnosing a particular hemodynamic condition within a well-defined target population). Several noninvasive methods are predictive of clinically significant portal hypertension (CSPH; hepatic venous pressure gradient [HVPG] ≥ 10 mm Hg; the threshold for complications of portal hypertension); however, only a minority of them have been evaluated in compensated advanced chronic liver disease (i.e., the target population). Importantly, most methods correlate only weakly with HVPG at high values (i.e., in patients with CSPH). Nevertheless, selected methods show promise for diagnosing HVPG ≥ 16 mm Hg (the cut-off for increased risks of hepatic decompensation and mortality) and monitoring HVPG changes in response to nonselective beta-blockers or etiological treatments. Finally, we review established and potential future clinical applications of noninvasive methods.

scholarly journals Noninvasive Evaluation of Portal Hypertension Using a Supervised Learning Technique

2017 ◽  
Vol 2017 ◽  
pp. 1-10 ◽  
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.

scholarly journals Brief Review of Portal Hypertension Related Complications

2021 ◽  
Author(s):  
Achyut Bikram Hamal
Keyword(s):  
Portal Hypertension ◽  
Pressure Gradient ◽  
Beta Blockers ◽  
Venous Pressure ◽  
Portal Pressure ◽  
Hepatopulmonary Syndrome ◽  
Portal Blood Flow ◽  
Variceal Hemorrhage ◽  
The Difference ◽  
Clinically Significant

The pathologic increase in the pressure gradient between portal vein and inferior venacava is called portal hypertension. Increased portal blood flow and increased resistance in the portal venous system cause portal hypertension. The structural components and the functional components contribute to the resistance. Hepatic venous pressure gradient (HVPG) reflects the degree of portal pressure in liver disease. HVPG is calculated as the difference between the wedged hepatic venous pressure (WHVP) and the free hepatic venous pressure (FHVP). Clinically significant portal hypertension (CSPH) is defined as HVPG ≥10. Different values of HVPG have been defined as threshold for different consequences of portal hypertension. Variceal hemorrhage, portal hypertensive gastropathy, ascites, colopathy, biliopathy and hepatopulmonary syndrome are main complications of portal hypertension. Besides nonselective beta blockers, other drugs like statins, antioxidants, antidiabetic, anti-inflammatory and antiapoptotic drugs have also been seen to be effective in reducing portal pressure.

scholarly journals Insulin resistance in patients with cirrhosis and portal hypertension

2012 ◽  
Vol 302 (12) ◽  
pp. G1458-G1465 ◽  
Author(s):  
Eva Erice ◽  
Elba Llop ◽  
Annalisa Berzigotti ◽  
Juan G. Abraldes ◽  
Ignacio Conget ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Portal Hypertension ◽  
Endothelial Dysfunction ◽  
Intracellular Signaling ◽  
Venous Pressure ◽  
Portal Pressure ◽  
Model Assessment ◽  
Hepatic Hemodynamics ◽  
Clinically Significant ◽  
The Relationship

Insulin resistance (IR) is involved in the pathogenesis of endothelial dysfunction and is also present in patients with cirrhosis. Intrahepatic endothelial dysfunction plays a major role, increasing hepatic vascular resistance and promoting portal hypertension (PH). In addition, β-adrenergic agonists and insulin share several intracellular signaling pathways. Thus IR may influence the response to β-blockers. This study aimed at evaluating the relationship between IR and hepatic hemodynamics in patients with cirrhosis and with the portal pressure response to acute β-blockade. Forty-nine patients with cirrhosis and PH were included. Hepatic and systemic hemodynamics were measured, and IR was estimated by using the updated homeostasis model assessment (HOMA)-2 index. Patients with HOMA-2 > 2.4 were considered IR. In patients with hepatic venous pressure gradient (HVPG) ≥ 10 mmHg) [clinically significant PH (CSPH)], hemodynamic measurements were performed again 20 min after intravenous propranolol. Mean HOMA-2 index was 3 ± 1.4. Fifty-seven percent of patients had IR. A weak correlation between HOMA-2 index and HVPG was observed. Eighty-six percent of patients had CSPH. HOMA-2 index was an independent predictor of CSPH. However, in patients with CSPH, the correlation between HOMA-2 index and HVPG was lost. HVPG, but not IR, predicted the presence of esophageal varices. Response to propranolol was not different between patients with or without IR. In nondiabetic patients with cirrhosis, HOMA-2 index is directly associated with the presence of CSPH and indirectly with varices, but does not allow either grading HVPG or predicting its response to propranolol.

Preventing decompensation of cirrhosis with clinically significant portal hypertension and without high-risk varices: a new indication for non-selective beta-blockers (NSBB)

2017 ◽  
Vol 66 (1) ◽  
pp. S97-S98 ◽  
Author(s):  
C. Villanueva ◽  
A. Albillos ◽  
J. Genescà ◽  
J.C. Garcia-Pagan ◽  
J.L. Calleja ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
High Risk ◽  
Beta Blockers ◽  
Clinically Significant

An unusual presentation of epigastric pain due to thrombophlebitis of a recanalised umbilical vein – case report

2019 ◽  
Vol 98 (8) ◽  
pp. 326-327 ◽  
Keyword(s):  
Liver Cirrhosis ◽  
Abdominal Pain ◽  
Case Report ◽  
Portal Hypertension ◽  
Liver Disease ◽  
Epigastric Pain ◽  
Umbilical Vein ◽  
History Of ◽  
Clinically Significant ◽  
Inflammatory Changes

Introduction: The umbilical vein can become recanalised due to portal hypertension in patients with liver cirrhosis but the condition is rarely clinically significant. Although bleeding from this enlarged vein is a known complication, the finding of thrombophlebitis has not been previously described. Case report: We report the case of a 62-year-old male with a history of liver cirrhosis due to alcoholic liver disease presenting to hospital with epigastric pain. A CT scan of the patient’s abdomen revealed a thrombus with surrounding inflammatory changes in a recanalised umbilical vein. The patient was managed conservatively and was discharged home the following day. Conclusion: Thrombophlebitis of a recanalised umbilical vein is a rare cause of abdominal pain in patients with liver cirrhosis.

Measuring Effectiveness

2018 ◽  
Author(s):  
Jacob Stegenga
Keyword(s):  
Outcome Measures ◽  
Relative Risk Reduction ◽  
Drug Approval ◽  
Target Population ◽  
Risk Difference ◽  
General Context ◽  
Measuring Instruments ◽  
Clinical Settings ◽  
Medical Interventions ◽  
Regulatory Standards

There are three methodological challenges to measuring the effectiveness of medical interventions: the choice of good measuring instruments, the use of appropriate analytic measures, and the use of a reliable method of extrapolating measures from an experimental context to a more general context. In practice each of these challenges contributes to overestimating the effectiveness of medical interventions. These challenges suggest corrective principles. The instruments employed in clinical research should measure patient-relevant and disease-specific parameters. Effectiveness always should be measured and reported using absolute outcome measures (such as ‘risk difference’), and we should employ caution when interpreting relative outcome measures (such as ‘relative risk reduction’). Extrapolating from research settings to clinical settings should more rigorously take into account possible ways in which interventions can fail to be effective in a target population. Current regulatory standards for drug approval are insufficient to manage these problems of measurement.

scholarly journals Clinically significant portal hypertension in cirrhosis patients with COVID-19: Clinical characteristics and outcomes

2020 ◽  
Vol 81 (2) ◽  
pp. e178-e180 ◽  
Author(s):  
Furong Liu ◽  
Xin Long ◽  
Guibao Ji ◽  
Bixiang Zhang ◽  
Wanguang Zhang ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Clinical Characteristics ◽  
Clinically Significant
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