title: Liver stiffness measurement predicts severe portal hypertension in patients with HCV-related cirrhosis.
abstract: Measurement of hepatic venous pressure gradient (HVPG) is a standard method for the assessment of portal pressure and correlates with the occurrence of its complications. Liver stiffness measurement (LSM) has been proposed as a noninvasive technique for the prediction of the complications of cirrhosis. In this study, we evaluated the ability of LSM to predict severe portal hypertension compared with that of HVPG in 61 consecutive patients with HCV-related chronic liver disease. A strong relationship between LSM and HVPG measurements was found in the overall population (r=0.81, P<0.0001). However, although the correlation was excellent for HVPG values less than 10 or 12 mm Hg (r=0.81, P=0.0003 and r=0.91, P<0.0001, respectively), linear regression analysis was not optimal for HVPG values>or=10 mm Hg (r2=0.35, P<0.0001) or>or=12 mm Hg (r2=0.17, P=0.02). The AUROC for the prediction of HVPG>or=10 and >or=12 mm Hg were 0.99 and 0.92, respectively and at LSM cutoff values of 13.6 kPa and 17.6 kPa, sensitivity was 97% and 94%, respectively. In patients with cirrhosis, LSM positively correlated with the presence of esophageal varices (P=0.002), although no correlation between LSM and esophageal varices size was detected. The area under the ROC for the prediction of EV was 0.76 and at a LSM cutoff value of 17.6 kPa sensitivity was 90%.
  
  
  CONCLUSIONS
  LSM represents a non-invasive tool for the identification of chronic liver disease patients with clinically significant or severe portal hypertension and could be employed for screening patients to be subjected to standard investigations including upper GI endoscopy and hemodynamic studies.
authors.affiliation: Dipartimento di Medicina Interna, Center for Research, Higher Education and Transfer DENOThe, Firenze, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Vizzutti
authors.forename: Umberto
authors.initials: U
authors.lastname: Arena
authors.forename: Roberto G
authors.initials: RG
authors.lastname: Romanelli
authors.forename: Luigi
authors.initials: L
authors.lastname: Rega
authors.forename: Marco
authors.initials: M
authors.lastname: Foschi
authors.forename: Stefano
authors.initials: S
authors.lastname: Colagrande
authors.forename: Antonio
authors.initials: A
authors.lastname: Petrarca
authors.forename: Stefania
authors.initials: S
authors.lastname: Moscarella
authors.forename: Giacomo
authors.initials: G
authors.lastname: Belli
authors.forename: Anna Linda
authors.initials: AL
authors.lastname: Zignego
authors.forename: Fabio
authors.initials: F
authors.lastname: Marra
authors.forename: Giacomo
authors.initials: G
authors.lastname: Laffi
authors.forename: Massimo
authors.initials: M
authors.lastname: Pinzani
mesh_terms: D000328:Adult; D000368:Aged; D003938:Diagnostic Techniques, Digestive System / Q000009:adverse effects; D004548:Elasticity; D004932:Esophageal and Gastric Varices / Q000175:diagnosis; D005260:Female; D006503:Hepatic Veins; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis*; D008099:Liver / Q000503:physiopathology*; D008103:Liver Cirrhosis / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis