Non-invasive model predicting clinically-significant portal hypertension in patients with advanced fibrosis.
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.
Park
Seung Ha
SH
Center for Liver and Digestive Diseases, Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea.
Park
Tae Eun
TE
Kim
Young Mook
YM
Kim
Sung Jung
SJ
Baik
Gwang Ho
GH
Kim
Jin Bong
JB
Kim
Dong Joon
DJ
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
D015415:Biomarkers; D001663:Bilirubin