title: Novel inflammatory biomarkers of portal pressure in compensated cirrhosis patients.
abstract: The rationale for screening inflammatory serum biomarkers of the hepatic vein pressure gradient (HVPG) is based on the fact that portal hypertension is pathogenically related to liver injury and fibrosis, and that in turn these are associated with the activation of inflammatory pathways. This was a nested cohort study in the setting of a randomized, clinical trial to assess the development of gastroesophageal varices (GEV) (N Engl J Med 2005;353:2254). Patients had cirrhosis and portal hypertension but did not have GEV. A total of 90 patients who had baseline day-1 sera available were enrolled in the present study. The objective of this study was to determine whether inflammatory biomarkers in conjunction with clinical parameters could be used to develop a predictive paradigm for HVPG. The correlations between HVPG and interleukin (IL)-1β (P=0.0052); IL-1R-α (P=0.0085); Fas-R (P=0.0354), and serum VCAM-1 (P=0.0007) were highly significant. By using multivariate logistic regression analysis and selected parameters (transforming growth factor beta [TGFβ]; heat shock protein [HSP]-70; at-risk alcohol use; and Child class B) we could exclude HVPG ≥ 12 mmHg with 86% accuracy (95% confidence interval [CI]: 67.78 to 96.16%) and the sensitivity was 87.01% (95% CI: 69.68 to 96.34%). Therefore, the composite test could identify 86% of compensated cirrhosis patients with HVPG below 12 mmHg and prevent unnecessary esophagogastroduodenoscopy with its associated morbidity and costs in these patients. Our diagnostic test was not efficient in predicting HVPG ≥ 12 mmHg.
  
  
  CONCLUSIONS
  A blood test for HVPG could be performed in cirrhosis patients to prevent unnecessary esophagogastroduodenoscopy.
authors.affiliation: Veterans Affairs San Diego Healthcare System, San Diego, CA; Department of Medicine, University of California, San Diego, La Jolla, CA; Biomedical Sciences Program, University of California, San Diego, La Jolla, CA.
authors.forename: Martina
authors.initials: M
authors.lastname: Buck
authors.forename: Guadalupe
authors.initials: G
authors.lastname: Garcia-Tsao
authors.forename: Roberto J
authors.initials: RJ
authors.lastname: Groszmann
authors.forename: Caitlin
authors.initials: C
authors.lastname: Stalling
authors.forename: Norman D
authors.initials: ND
authors.lastname: Grace
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Burroughs
authors.forename: David
authors.initials: D
authors.lastname: Patch
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Matloff
authors.forename: Paul
authors.initials: P
authors.lastname: Clopton
authors.forename: Mario
authors.initials: M
authors.lastname: Chojkier
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D004932:Esophageal and Gastric Varices / Q000276:immunology / Q000378:metabolism / Q000517:prevention & control*; D005260:Female; D006503:Hepatic Veins / Q000503:physiopathology; D006521:Hepatitis, Chronic / Q000276:immunology / Q000378:metabolism / Q000503:physiopathology; D006801:Humans; D006975:Hypertension, Portal / Q000276:immunology* / Q000378:metabolism* / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000276:immunology* / Q000378:metabolism* / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure / Q000502:physiology; D011446:Prospective Studies; D012680:Sensitivity and Specificity
chemical_list: D000319:Adrenergic beta-Antagonists; D015415:Biomarkers