title: Non-invasive model predicting clinically-significant portal hypertension in patients with advanced fibrosis.
abstract: OBJECTIVE
  Hepatic venous pressure gradient (HVPG) has been established as a predictor for the development of varices, clinical decompensation and death. In the present study, the primary objectives were to determine the diagnostic accuracy of the model developed by using readily-available data in predicting the presence of significant portal hypertension and esophageal varices.
  
  
  METHODS
  This study included a total of 61 consecutive treatment-naive patients with advanced fibrosis (METAVIR F3, F4), established by liver biopsy. All patients underwent subsequent HVPG measurement and upper gastrointestinal endoscopy within 1 week of liver biopsy.
  
  
  RESULTS
  Seventeen patients (F3, 2/26; F4, 15/35) had clinically-significant portal hypertension (HVPG > or = 10 mmHg). The Risk Score for predicting significant portal hypertension was 14.2 - 7.1 x log(10) (platelet [10(9)/L]) + 4.2 x log(10) (bilirubin [mg/dL]). The area under the receiver-operator curve (AUC) curve was 0.91 (95% confidence interval [CI], 0.84-0.98). The optimized cut-off value (Risk Score = -1.0) offered a sensitivity of 88% (95% CI, 62-98%) and a specificity of 86% (95% CI, 72-94%). The AUC of the Risk Score in predicting varices was 0.82 (95% CI, 0.67-0.98). The cut-off had a sensitivity of 82% (95% CI, 48-97%) and a specificity of 76% (95% CI, 62-86%).
  
  
  CONCLUSIONS
  A predictive model that uses readily-available laboratory results may reliably identify advanced fibrosis patients with clinically-significant portal hypertension as well as esophageal varices. However, before accepted, the results of the current study certainly should be validated in larger prospective cohorts.
authors.affiliation: Center for Liver and Digestive Diseases, Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea.
authors.forename: Seung Ha
authors.initials: SH
authors.lastname: Park
authors.forename: Tae Eun
authors.initials: TE
authors.lastname: Park
authors.forename: Young Mook
authors.initials: YM
authors.lastname: Kim
authors.forename: Sung Jung
authors.initials: SJ
authors.lastname: Kim
authors.forename: Gwang Ho
authors.initials: GH
authors.lastname: Baik
authors.forename: Jin Bong
authors.initials: JB
authors.lastname: Kim
authors.forename: Dong Joon
authors.initials: DJ
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D018450:Disease Progression; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D010976:Platelet Count; D011237:Predictive Value of Tests; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014690:Venous Pressure; D055815:Young Adult
chemical_list: D015415:Biomarkers; D001663:Bilirubin