title: Baseline and serial liver stiffness measurement in prediction of portal hypertension progression for patients with compensated cirrhosis.
abstract: OBJECTIVE
  Liver stiffness measurement (LSM) using transient elastography is useful in prediction of significant portal hypertension (PHT). To evaluate the usefulness of baseline and serial LSM in predicting clinical disease progression (CDP) for patients with compensated hepatic cirrhosis.
  
  
  METHODS
  Consecutive patients with compensated cirrhosis and without hepatocellular carcinoma (HCC) were prospectively enrolled. Baseline LSM was assessed at enrolment, then at a 6- to 12-month interval. Esophagogastroduodenoscopy and ultrasonography were performed regularly for surveillance of varices and HCC, while CDP including HCC development and PHT progression was recorded.
  
  
  RESULTS
  Two hundred and twenty patients were enrolled. In a median follow-up of 36.9 months, CDP were detected in 49 patients including 30 PHT progression and 19 HCC developments. The cumulative incidence of CDP, PHT progression and HCC development at 3 years was 20.7%, 12.8% and 9.1% respectively. Multivariate analyses showed that baseline LSM was an independent predictor of PHT progression and CDP, however, not of HCC occurrence. The performance of baseline LSM in predicting PHT progression, varices growth/development and hepatic decompensation was 0.744, 0.638 and 0.929. With 17, 12 and 21.1 kPa as the cut-off, the negative predictive value was 92, 94 and 99% respectively. Patients with baseline LSM ≧17 kPa without serial changes had higher risk of PHT progression.
  
  
  CONCLUSIONS
  For patients with compensated cirrhosis, LSM was an independent predictor of PHT progression and CDP, but not of HCC occurrence. Baseline LSM was useful to exclude PHT progression. Patients with baseline and serial LSM ≧17 kPa had higher risk of PHT progression.
authors.affiliation: Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Jing-Houng
authors.initials: JH
authors.lastname: Wang
authors.forename: Seng-Kee
authors.initials: SK
authors.lastname: Chuah
authors.forename: Sheng-Nan
authors.initials: SN
authors.lastname: Lu
authors.forename: Chao-Hung
authors.initials: CH
authors.lastname: Hung
authors.forename: Chung-Mou
authors.initials: CM
authors.lastname: Kuo
authors.forename: Wei-Chen
authors.initials: WC
authors.lastname: Tai
authors.forename: Shue-Shian
authors.initials: SS
authors.lastname: Chiou
mesh_terms: D019540:Area Under Curve; D001499:Bayes Theorem; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000209:etiology; D018450:Disease Progression; D004548:Elasticity; D054459:Elasticity Imaging Techniques / Q000379:methods; D016145:Endoscopy, Digestive System; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology*; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology*; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve
keywords: hepatic decompensation; hepatocellular carcinoma (HCC); portal hypertension (PHT); transient elastography