title: Hepatic venous pressure gradient supplements liver biopsy in the diagnosis of cirrhosis.
abstract: BACKGROUND
  Liver biopsy is the gold standard for establishing cirrhosis, but may provide inadequate tissue for interpretation in some patients.
  
  
  OBJECTIVE
  The aim of this study was to determine whether the hepatic venous pressure gradient predicts the presence of cirrhosis.
  
  
  METHODS
  Patients with liver disease who had undergone hepatic venous pressure gradient measurements were identified. Clinical, laboratory, and hepatic venous pressure gradient data were collected and biopsies were staged for fibrosis. Univariable logistic regression was used to identify potential predictors of cirrhosis. Multivariable logistic regression was applied to determine adjusted odds ratios.
  
  
  RESULTS
  Thirty-two patients were included. The hepatic venous pressure gradient was an independent predictor of cirrhosis. On multivariable analysis, the hepatic venous pressure gradient predicted cirrhosis, with an odds ratio of 1.46 (95% confidence interval 1.05-2.02, P=0.023). Using a cutoff of >or=6.5 mm Hg, the hepatic venous pressure gradient was 86% sensitive and 80% specific for diagnosing cirrhosis.
  
  
  CONCLUSIONS
  The hepatic venous pressure gradient measurement predicts the presence of cirrhosis in patients with liver disease. Therefore, when the diagnosis of cirrhosis is in question, an elevated hepatic venous pressure gradient can support the diagnosis.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA. atwolf@partners.org
authors.forename: Anne T
authors.initials: AT
authors.lastname: Wolf
authors.forename: Rie
authors.initials: R
authors.lastname: Maurer
authors.forename: Jonathan
authors.initials: J
authors.lastname: Glickman
authors.forename: Norman D
authors.initials: ND
authors.lastname: Grace
mesh_terms: D000328:Adult; D001706:Biopsy; D015331:Cohort Studies; D005260:Female; D006503:Hepatic Veins / Q000502:physiology*; D006801:Humans; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000473:pathology* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014690:Venous Pressure