from berlin conference 2011
The prognosis of patients with chronic liver disease is to a great extent determined by the presence and degree of portal hypertension (PHT). Hepatic venous pressure gradient (HVPG) has been shown to be an accurate prognostic index in patients with cirrhosis. Transient elastography is a non-invasive procedure that assesses liver fibrosis through the measurement of liver stiffness (LS). In several reports, LS was found to be correlated with HVPG. LS could therefore be useful to identify patients with significant PHT. The aim of the present study was to prospectively assess and to compare the prognostic performances of LS and HVPG in patients with chronic liver disease.
Patients and Methods:
One hundred patients with chronic liver disease underwent LS and HVPG measures on the same day. Patients were thereafter followed-up for 2 years, or until they experienced a complication related to their liver disease. Results: Within the 2 year follow-up, 41 patients developed, at least, one liver disease related complication. The performances of HVPG and LS for predicting the occurrence of these complications were not significantly different: AUROC 0.815 [0.727 - 0.903] and 0.837 [0.754 - 0.920], respectively. When considering only complications related to PHT, both methods were found to be similarly accurate: AUROC 0.830 [0.751 - 0.910] and 0.845 [0.767 - 0.823], for HVPG and LS, respectively. When patients were divided in 2 groups according to a LS value below or above 21.1 kPa, actuarial rates of remaining free of any complication at two years were 85.4% vs. 29.5%, respectively. When only PHT related complications were considered, these rates were 100% vs. 47.5%, respectively. The performances of LS and HVPG were also similar in the subgroup of 65 patients with cirrhosis.
Conclusion: LS proved as effective as HVPG in predicting clinical decompensation and PHT related complications in patients with chronic liver disease. Therefore, LS could be a valuable clinical tool to avoid invasive procedures.
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