Faculty Opinions recommendation of A Meta-analysis for the Diagnostic Performance of Transient Elastography for Clinically Significant Portal Hypertension.

ObjectiveThis meta-analysis was performed to investigate the correlation between von Willebrand factor (vWF) antigen and hepatic venous pressure gradient (HVPG) and to evaluate the diagnostic performance of vWF to detect clinically significant portal hypertension (CSPH) and severe portal hypertension (SPH).DesignSystematic review and meta-analysis.MethodsMEDLINE, EMBASE, Web of Science and the Cochrane Library were screened up to 5 April 2018. Studies related to the diagnostic performance of vWF to detect CSPH and/or SPH with HVPG as the reference standard were included. Study quality was assessed by using the Quality Assessment of Diagnostic Accuracy Studies scale. Two authors independently used a standardised form to extract data.OutcomesThe primary outcome was the correlation coefficient between vWF and HVPG. The secondary outcome was the diagnostic performance of vWF to detect CSPH or SPH.ResultsA total of six articles involving 994 patients were included in this study. Five of the included articles were used to stratify the results for the correlation coefficient, three for the diagnostic performance of CSPH and two for SPH. The pooled correlation coefficient based on the random effects model was 0.54 (95% CI 0.35 to 0.69), thus suggesting a moderate correlation between vWF and HVPG. The pooled sensitivity, specificity and area under the curve of vWF for CSPH detection were 82% (95% CI 78 to 86), 76% (95% CI 68 to 83) and 0.87 (95% CI 0.80 to 0.94), respectively. Regarding the ability of vWF to detect SPH, the pooled sensitivity and specificity were 86% (95% CI 80 to 90) and 75% (95% CI 66 to 83), respectively. These results supported the satisfactory diagnostic performance of vWF for CSPH and SPH detection.ConclusionsvWF, as a novel biomarker, has a moderate correlation with HVPG and shows a satisfactory performance for the diagnosis of CSPH and SPH in patients with cirrhosis.

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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.

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Diagnostic Performance of Ultrasound Elastography for Evaluating Portal Hypertension in Children: A Systematic Review and Meta-analysis

Journal of Ultrasound in Medicine ◽

10.1002/jum.14764 ◽

2018 ◽

Vol 38 (3) ◽

pp. 747-759 ◽

Cited By ~ 4

Author(s):

Dong Wook Kim ◽

Hee Mang Yoon ◽

Ah Young Jung ◽

Jin Seong Lee ◽

Seak Hee Oh ◽

...

Keyword(s):

Systematic Review ◽

Portal Hypertension ◽

Diagnostic Performance ◽

Meta Analysis ◽

Ultrasound Elastography ◽

Hypertension In Children

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Reliability of Transient Elastography-Based Liver Stiffness for Diagnosing Portal Hypertension in Patients with Alcoholic Liver Disease: A Diagnostic Meta-Analysis with Specific Cut-Off Values

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/a-0731-0178 ◽

2019 ◽

Vol 41 (01) ◽

pp. 60-68 ◽

Cited By ~ 5

Author(s):

Jinzhen Song ◽

Zida Ma ◽

Jianbo Huang ◽

Yan Luo ◽

Romanas Zykus ◽

...

Keyword(s):

Portal Hypertension ◽

Liver Disease ◽

Sensitivity And Specificity ◽

Alcoholic Liver Disease ◽

Transient Elastography ◽

Meta Analysis ◽

Liver Stiffness ◽

Cochrane Library ◽

Bivariate Model ◽

Disease Etiology

Abstract Background Transient elastography-based liver stiffness value (TE-LSV) has been studied for the diagnosis of portal hypertension. Liver stiffness is influenced by the disease etiology. We aimed to perform a meta-analysis to determine the performance of TE-LSV for diagnosing portal hypertension in patients with alcoholic liver disease (ALD). Methods We searched PubMed, Web of Science, Ovid and Cochrane library. A bivariate model was used to compute sensitivity and specificity. A random effects model was used to pool diagnostic odds ratios. Results 9 studies with 679 patients were included. The pooled sensitivity and specificity based on a cut-off value around 21.8 kPa for clinically significant portal hypertension (CSPH) were 0.89 (95 % confidence interval (CI), 0.83–0.93) and 0.71(95 % CI, 0.64–0.78), respectively. For severe portal hypertension (SPH), the pooled sensitivity and specificity for a cut-off value around 29.1 kPa were 0.88 (95 % CI, 0.83–0.92) and 0.74 (95 % CI, 0.67–0.81), respectively. Conclusion TE-LSV showed good performance for diagnosing portal hypertension in patients with ALD. The optimal cut-off value for CSPH and SPH was around 21.8 kPa and 29.1 kPa, respectively, and these two cut-off values showed good sensitivity and modest specificity. The etiology should be clear before using TE-LSV for portal hypertension.

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