title: Liver stiffness accurately predicts portal hypertension related complications in patients with chronic liver disease: a prospective study.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  One hundred patients with chronic liver disease underwent LS and HVPG measurements 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 two-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 two groups according to a LS value below or above 21.1kPa, actuarial rates of remaining free of any complication at 2 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Service d'Hepato-gastro-entérologie, Pôle Digestif CHU Toulouse, Purpan 31059, Toulouse cedex, France.
authors.forename: Marie Angèle
authors.initials: MA
authors.lastname: Robic
authors.forename: Bogdan
authors.initials: B
authors.lastname: Procopet
authors.forename: Sophie
authors.initials: S
authors.lastname: Métivier
authors.forename: Jean Marie
authors.initials: JM
authors.lastname: Péron
authors.forename: Janick
authors.initials: J
authors.lastname: Selves
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Vinel
authors.forename: Christophe
authors.initials: C
authors.lastname: Bureau
mesh_terms: D000368:Aged; D019540:Area Under Curve; D002908:Chronic Disease; D004548:Elasticity / Q000502:physiology; D054459:Elasticity Imaging Techniques; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000209:etiology; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology*; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000150:complications / Q000503:physiopathology; D008107:Liver Diseases / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017082:Portal Pressure; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve