title: Indocyanine green retention test as a noninvasive marker of portal hypertension and esophageal varices in compensated liver cirrhosis.
abstract: Noninvasive markers would be useful for the assessment of portal hypertension (PH) and esophageal varices (EV) in patients with cirrhosis. The aim of our study was to evaluate the performance of the indocyanine green (ICG) retention test as a noninvasive marker of PH and EV, measured against the gold standards (hepatic venous pressure gradient [HVPG] measurement and upper endoscopy). We prospectively enrolled patients with compensated cirrhosis referral to our unit. All patients underwent laboratory tests, abdominal ultrasound, upper gastrointestinal endoscopy, HVPG measurement, and the ICG 15-minute retention (ICG-r15) test. We evaluated the sensitivity and specificity of the ICG retention test and other noninvasive tools for the diagnosis of PH and EV. Ninety-six consecutive Child-Pugh A patients (67 male and 29 female; 60.3 ± 11.8 years of age) were enrolled. Seventy-four patients had clinically significant portal hypertension (CSPH), of whom 59 had severe portal hypertension (SPH). ICG-r15 and Lok index were independently related to the presence of both CSPH and SPH, whereas ICG-r15 and INR were related to EV. ICG-r15 values (<6.7% and <6.9%, respectively) were able to rule out the presence of CSPH and SPH (LR(-) 0.15 and 0.14); ICG-r15 <10% provided a 97.8% sensitivity (LR(-) 0.042) for the exclusion of EV and a 100% sensitivity (LR(-) 0.0) for large EV.
  
  
  CONCLUSIONS
  The ICG-r15 test is an effective tool for assessment of PH in patients with compensated cirrhosis. Although this would not replace endoscopy, the ICG-r15 appears able to identify patients with advanced liver disease in which endoscopy is mandatory as well as rule out the presence of EV in patients with compensated cirrhosis.
authors.affiliation: Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Lisotti
authors.forename: Francesco
authors.initials: F
authors.lastname: Azzaroli
authors.forename: Federica
authors.initials: F
authors.lastname: Buonfiglioli
authors.forename: Marco
authors.initials: M
authors.lastname: Montagnani
authors.forename: Paolo
authors.initials: P
authors.lastname: Cecinato
authors.forename: Laura
authors.initials: L
authors.lastname: Turco
authors.forename: Claudio
authors.initials: C
authors.lastname: Calvanese
authors.forename: Patrizia
authors.initials: P
authors.lastname: Simoni
authors.forename: Massimo
authors.initials: M
authors.lastname: Guardigli
authors.forename: Rosario
authors.initials: R
authors.lastname: Arena
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cucchetti
authors.forename: Antonio
authors.initials: A
authors.lastname: Colecchia
authors.forename: Davide
authors.initials: D
authors.lastname: Festi
authors.forename: Rita
authors.initials: R
authors.lastname: Golfieri
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mazzella
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D003430:Cross-Sectional Studies; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology*; D015994:Incidence; D007208:Indocyanine Green / Q000378:metabolism*; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013997:Time Factors; D014690:Venous Pressure / Q000502:physiology
chemical_list: D015415:Biomarkers; D007208:Indocyanine Green