Portal hypertension is the main driver of liver stiffness in advanced liver cirrhosis

Liver stiffness (LS) is a novel non-invasive parameter widely used in clinical hepatology. LS correlates with liver fibrosis stage in non-cirrhotic patients. In cirrhotic patients it also shows good correlation with Hepatic Venous Pressure Gradient (HVPG). Our aim was to assess the contribution of liver fibrosis and portal hypertension to LS in patients with advanced liver cirrhosis. Eighty-one liver transplant candidates with liver cirrhosis of various aetiologies underwent direct HVPG and LS measurement by 2D shear-wave elastography (Aixplorer Multiwave, Supersonic Imagine, France). Liver collagen content was assessed in the explanted liver as collagen proportionate area (CPA) and hydroxyproline content (HP). The studied cohort included predominantly patients with Child-Pugh class B and C (63/81, 77.8 %), minority of patients were Child-Pugh A (18/81, 22.2 %). LS showed the best correlation with HVPG (r=0.719, p<0.001), correlation of LS with CPA (r=0.441, p<0.001) and HP/Amino Acids (r=0.414, p< 0.001) was weaker. Both variables expressing liver collagen content showed good correlation with each other (r=0.574, p<0.001). Multiple linear regression identified the strongest association between LS and HVPG (p<0.0001) and weaker association of LS with CPA (p = 0.01883). Stepwise modelling showed minimal increase in r2 after addition of CPA to HVPG (0.5073 vs. 0.5513). The derived formula expressing LS value formation is: LS=2.48 + (1.29 x HVPG) + (0.26 x CPA). We conclude that LS is determined predominantly by HVPG in patients with advanced liver cirrhosis whereas contribution of liver collagen content is relatively low.

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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.

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“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.

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Liver Retraction Using n-Butyl-2-Cyanoacrylate (NBCA) Glue during Laparoscopic Splenectomy and Azygoportal Disconnection in Cirrhotic Patients

BioMed Research International ◽

10.1155/2018/3064046 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Du Kong ◽

Wei Wang ◽

Gang Du ◽

Binyao Shi ◽

Zhengchen Jiang ◽

...

Keyword(s):

Liver Cirrhosis ◽

Portal Hypertension ◽

Liver Function ◽

Blood Loss ◽

Laparoscopic Splenectomy ◽

Postoperative Bleeding ◽

Gastroesophageal Varices ◽

Liver Retraction ◽

Significant Difference ◽

Cirrhotic Patients

Background. Although liver retraction using n-butyl-2-cyanoacrylate (NBCA) glue has been applied to laparoscopic upper abdominal surgery in noncirrhotic patients, there is still no consensus on its safety and feasibility for cirrhotic patients. In this study, we aimed to investigate the safety and effectiveness of liver retraction using NBCA glue during laparoscopic splenectomy and azygoportal disconnection (LSD) for gastroesophageal varices and hypersplenism secondary to liver cirrhosis and portal hypertension. Methods. Thirty-nine gastroesophageal varices and hypersplenism secondary to liver cirrhosis and portal hypertension patients were included in our study. We performed LSD in the presence of NBCA glue (n = 22, NBCA group) and absence of NBCA glue (n = 17, n-NBCA group), respectively. The operation time, blood loss, postoperative hospitalization, and liver function were compared between the two groups. Results. There was no mortality during the operation. One patient in non-NBCA group received open surgery due to parenchyma hemorrhage. Postoperative pleural effusion occurred in 2 cases of the NBCA group and 1 of the non-NBCA group. One showed left subphrenic abscess in the non-NBCA group. No postoperative bleeding occurred after 9-30 months of follow-up. The time of operation in NBCA group was significantly shorter than those in n-NBCA group (198.86±17.86 versus 217.81±20.25min, P<0.01). Blood loss in NBCA group was significantly lower than non-NBCA group (159.09±56.98 versus 212.50±88.51 ml, P<0.05). The levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were increased on day 1 after LSD and decreased to normal level on day 7 after LSD in both groups. There was no significant difference in postoperative hospitalization and liver function between the two groups. Conclusion. Liver retraction using NBCA glue during LSD for gastroesophageal varices and hypersplenism secondary to liver cirrhosis and portal hypertension is safe, effective, and feasible.

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Assessment of Spleen Stiffness for Prediction of Varices in Patients with Hepatitis C Related Cirrhosis Using Transient Elastography

International Journal of TROPICAL DISEASE & Health ◽

10.9734/ijtdh/2020/v41i2430421 ◽

2020 ◽

pp. 9-18

Author(s):

Naglaa El-Toukhy Ramadan El-Toukhy ◽

Sharaf Elsayed Ali Hassanien ◽

Ramy A. Metwaly ◽

Medhat A. Khalil ◽

Badawy A. Abdulaziz

Keyword(s):

Liver Cirrhosis ◽

Hepatitis C ◽

Esophageal Varices ◽

Predictive Value ◽

Transient Elastography ◽

Liver Stiffness ◽

Diagnostic Value ◽

Group I ◽

Spleen Stiffness ◽

Cirrhotic Patients

Background and Study Aims: Portal hypertension is one of the most important complications of liver cirrhosis. The prevalence of varices among cirrhotic patients is variable. Therefore, endoscopic screening of all patients with liver cirrhosis would result in a large number of unnecessary additional burdens to endoscopic units. Our aim was to assess the diagnostic accuracy of spleen stiffness measured by transient elastography (Fibroscan) for prediction of the presence of varices in patients with hepatitis C related cirrhosis. Patients and Methods: The study was carried out on 100 patients with HCV-induced cirrhosis and were divided into 2 groups according to presence or absence of varices by Esophago-gastro-duodenoscopy: Group I: patients with HCV-induced cirrhosis with varices; Group II: patients with HCV-induced cirrhosis without varices. Clinical and laboratory parameters, andominal ultrasonography, Upper gastrointestinal endoscopy and transient elastography to assess the liver and spleen stiffness were carried out to all studied persons. Results: Spleen stiffness had significant diagnostic value to differentiate between cirrhotic patients with varices and cirrhotic patients without varices , it had significant diagnostic value in presence of esophageal varices at cut-off (≥46.4 K Pascal) the sensitivity for detection of esophageal varices was 93%, specificity 100%, positive predictive value (PPV) was 80%, negative predictive value (NPV) was 100%; accuracy was 95% and area under the curve was 0.98 denoting that spleen stiffness is a good predictor of esophageal varices. Conclusion: Spleen stiffness was considered as an excellent predictor of esophageal varices and better than liver stiffness in prediction of esophageal varices presence and had significant diagnostic value to differentiate between the patients with varices and patients without varices at cut off (≥46.4 K Pascal) and it may have a role in variceal grading.

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Noninvasive assessment of oesophageal varices presence and size in patients with liver cirrhosis using right liver lobe/serum albumin concentration

Vojnosanitetski pregled ◽

10.2298/vsp0707453a ◽

2007 ◽

Vol 64 (7) ◽

pp. 453-457

Author(s):

Tamara Alempijevic ◽

Vladislava Bulat ◽

Nada Kovacevic ◽

Rada Jesic ◽

Srdjan Djuranovic ◽

...

Keyword(s):

Liver Cirrhosis ◽

Portal Hypertension ◽

Oesophageal Varices ◽

Digestive Endoscopy ◽

Liver Lobe ◽

Albumin Ratio ◽

Cirrhotic Patients ◽

The Mean ◽

Upper Digestive Endoscopy ◽

The Right

Background/Aim. Liver cirrhosis is a chronic, progressive disease and it is usually accompanied by portal hypertension. The development of oesophageal varices (OV) is one of the major complications of portal hypertension. Cirrhotic patients should be screened for the presence of OV when portal hypertension is diagnosed. In order to reduce the increasing burden that endoscopy units have to bear, some studies have attempted to identify parameters for noninvasive prediction of OV presence. The aim of our study was to evaluate the value of biochemical and ultrasonography parameters for prediction of OV presence. Methods. This study included 58 cirrhotic patients who underwent a complete biochemical workup, ultrasonography examination and upper digestive endoscopy. Right liver lobe diameter/albumin ratio was calculated and its correlation to the presence and degree of OV, and Child-Pugh score of liver cirrhosis explored. Results. The mean age of the patients included in the study was 53.07?13.09 years; 40 were males and 18 females. In the Child-Pugh class A were 53.4% patients, class B 39.7%, whereas 6.9% were in the class C. In 24.1% of the patients no OV were identified by upper digestive endoscopy, 19% had OV grade I, 34.5% grade II, 20.7% grade III, and 1.7% OV grade IV. The mean value of the right liver lobe diameter/ albumin ratio was 5.43?1.79 (range of 2.76?11.44). Statistically significant correlation (p < 0.01) was confirm by Spearman's test between OV grade and calculated index (? = 0.441). Conclusion. The right liver lobe diameter/albumin ratio is a noninvasive parameter which provides an accurate information pertinent to the determination of OV presence and their grading in patients with liver cirrhosis. .

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Hepatic Hydrothorax in a Patient with Liver Cirrhosis: a Case Report

Current Internal Medicine Research and Practice Surabaya Journal ◽

10.20473/cimrj.v2i2.28702 ◽

2021 ◽

Vol 2 (2) ◽

pp. 42

Author(s):

Martino Handoyo ◽

Titong Sugihartono

Keyword(s):

Liver Cirrhosis ◽

Case Report ◽

Portal Hypertension ◽

Pleural Effusion ◽

Ascitic Fluid ◽

Pleural Space ◽

Sodium Restriction ◽

Hepatic Hydrothorax ◽

Lower Survival Rate ◽

Advanced Liver Cirrhosis

Hepatic hydrothorax is a transudative pleural effusion which presents in 5-10% patients with liver cirrhosis. Although fairly uncommon, it is associated with higher morbidity and lower survival rate. The mechanism is yet to be understood fully, but the most widely accepted pathogenesis involves the presence of portal hypertension, diaphragmatic defects, and negative intrathoracal pressure, all of which lead to the formation of unidirectional passage of ascitic fluid from peritoneal cavity into pleural space. Due to its origin, the pleural effusion has similar characteristics to ascitic fluid. We herein report the case of a 60-year-old woman with advanced liver cirrhosis and right-sided moderate hepatic hydrothorax. Treatment given to the patient includes diuretics, sodium restriction, and repeated thoracentesis. Subsequent evaluation of the patient revealed improvement both clinically and radiologically.

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Systemic and Splanchnic Lipopolysaccharide and Endothelin-1 Plasma Levels in Liver Cirrhosis before and after Transjugular Intrahepatic Portosystemic Shunt

Gastroenterology Research and Practice ◽

10.1155/2016/8341030 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Jiaxiang Meng ◽

Qing Wang ◽

Kai Liu ◽

Shuofei Yang ◽

Xinxin Fan ◽

...

Keyword(s):

Blood Flow ◽

Liver Cirrhosis ◽

Portal Hypertension ◽

Portal Vein ◽

Transjugular Intrahepatic Portosystemic Shunt ◽

Bacterial Translocation ◽

Portosystemic Shunt ◽

Before And After ◽

Intrahepatic Portosystemic Shunt ◽

Cirrhotic Patients

Lipopolysaccharide (LPS) and endothelin- (ET-) 1 may aggravate portal hypertension by increasing intrahepatic resistance and splanchnic blood flow. In the portal vein, after TIPS shunting, LPS and ET-1 were significantly decreased. Our study suggests that TIPS can benefit cirrhotic patients not only in high hemodynamics related variceal bleeding but also in intestinal bacterial translocation associated complications such as endotoxemia.

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Abstract 12308: Assessment of Liver Fibrosis Using Magnetic Resonance Elastography in Children Who Undergo the Fontan Procedure and Intracardiac Repair

Circulation ◽

10.1161/circ.130.suppl_2.12308 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Masaya Sugimoto ◽

Hideharu Oka ◽

Aya Kajihama ◽

Kouichi Nakau ◽

Hiroshi Azuma

Keyword(s):

Magnetic Resonance ◽

Liver Fibrosis ◽

Fontan Procedure ◽

Venous Pressure ◽

Liver Stiffness ◽

Magnetic Resonance Elastography ◽

Cardiac Biomarkers ◽

Control Group ◽

Intracardiac Repair ◽

Significant Difference

Background: The incidence of late complications related to the liver such as fibrosis/cirrhosis is increasing in patients who have undergone the Fontan procedure and may contribute to morbidity and mortality. Recently, magnetic resonance elastography (MRE), a novel evaluation technique of liver fibrosis, has been attracting attention. However, few reports have described the use of MRE for evaluating liver fibrosis in children with congenital heart disease (CHD). Methods: Thirty-two children were examined and divided into 4 groups: 12 children with CHD who underwent intracardiac repair (ICR; median age, 13.0 years); 10 with CHD who underwent the Fontan procedure (Fontan; 15.3 years); 8 who were included in the control group (control; 15.8 years); and 2 children with cirrhosis (cirrhosis; 16.3 years). The liver stiffness (LS) was estimated by MRE. LS was measured 3 times consecutively, and the mean value was considered for further analysis. Central venous pressure (CVP) and cardiac index (C.I.) were determined by cardiac catheterization. The levels of cardiac biomarkers (NTproBNP and PIIIP) were determined at the same time. Results: Among the 4 groups, no significant differences were observed in age, C.I., and NTproBNP levels. The PIIIP levels in the cirrhosis group were significantly higher than those in the control, but no significant difference in PIIIP levels was found among the other groups (p < 0.01). LS in the Fontan and cirrhosis group was significantly higher than that in the control group (5.6, 15.3 vs. 2.4 kPa, respectively; Fig. 1). Furthermore, there was a strong correlation between LS and CVP (r = 0.802; Fig. 2). Conclusions: This study showed that LS is a direct function of CVP, which should be considered when assessing the degree of liver fibrosis in children with CHD. In particular, in the case of children who undergo the Fontan procedure, the highly sensitive MRE can be used to evaluate liver fibrosis and help detect LS earlier than cardiac biomarkers do.

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The study of hepatic hemodynamics: research activity or clinical tool?

Italian Journal of Medicine ◽

10.4081/itjm.2010.201 ◽

2013 ◽

pp. 201-206

Author(s):

Claudio Puoti ◽

Lia Bellis

Keyword(s):

Portal Hypertension ◽

Venous Pressure ◽

Preoperative Assessment ◽

Clinical Tool ◽

Research Activity ◽

Acute Variceal Bleeding ◽

Routine Work ◽

Hepatic Hemodynamics ◽

Pros And Cons ◽

Cirrhotic Patients

Portal hypertension is a progressive complication of cirrhosis. Therefore, the management of a patient with cirrhosis and gastrointestinal bleeding depends largely on the stage of the portal hypertension. The patient may be in the pre-variceal stage or present with acute variceal bleeding, in which case the objectives are to control the current hemorrhage and prevent recurrence. In clinical practice, the severity of portal hypertension can be estimated, reliably and safely, by transjugular measurement of the hepatic venous pressure gradient (HVPG). After a brief review of the pathophysiology of portal hypertension in cirrhosis, the authors describe the technique used to measure transjugular HVPG, its prognostic value in patients with cirrhosis, the pros and cons of including this procedure in routine work-ups of these patients, and its potential roles in monitoring responses to treatment and in the preoperative assessment of cirrhotic patients undergoing hepatic resection.

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