Serum tests, liver stiffness and artificial neural networks for diagnosing cirrhosis and portal hypertension.
BACKGROUND
The diagnostic performance of biochemical scores and artificial neural network models for portal hypertension and cirrhosis is not well established.


OBJECTIVE
To assess diagnostic accuracy of six serum scores, artificial neural networks and liver stiffness measured by transient elastography, for diagnosing cirrhosis, clinically significant portal hypertension and oesophageal varices.


METHODS
202 consecutive compensated patients requiring liver biopsy and hepatic venous pressure gradient measurement were included. Several serum tests (alone and combined into scores) and liver stiffness were measured. Artificial neural networks containing or not liver stiffness as input variable were also created.


RESULTS
The best non-invasive method for diagnosing cirrhosis, portal hypertension and oesophageal varices was liver stiffness (C-statistics=0.93, 0.94, and 0.90, respectively). Among serum tests/scores the best for diagnosing cirrhosis and portal hypertension and oesophageal varices were, respectively, Fibrosis-4, and Lok score. Artificial neural networks including liver stiffness had high diagnostic performance for cirrhosis, portal hypertension and oesophageal varices (accuracy>80%), but were not statistically superior to liver stiffness alone.


CONCLUSIONS
Liver stiffness was the best non-invasive method to assess the presence of cirrhosis, portal hypertension and oesophageal varices. The use of artificial neural networks integrating different non-invasive tests did not increase the diagnostic accuracy of liver stiffness alone.
University of Medicine and Pharmacy "Iuliu Hatieganu", 3rd Medical Clinic, Gastroenterology Department, Cluj-Napoca, Romania; Regional Institute of Gastroenterology and Hepatology "O Fodor", Gastroenterology Department, Cluj-Napoca, Romania; Hepatology, University Clinic for Visceral Surgery and Medicine, Berne-Inselspital, Switzerland. Electronic address: bogdanprocopet@gmail.com.
Bogdan
B
Procopet
Babeş-Bolyai University, Faculty of Chemistry and Chemical Engineering, Department of Chemical Engineering, Cluj-Napoca, Romania.
Vasile Mircea
VM
Cristea
Department of Hepato-Gastroenterology, Purpan Hospital, CHU Toulouse, France.
Marie Angele
MA
Robic
Regional Institute of Gastroenterology and Hepatology "O Fodor", Gastroenterology Department, Cluj-Napoca, Romania.
Mircea
M
Grigorescu
Babeş-Bolyai University, Faculty of Chemistry and Chemical Engineering, Department of Chemical Engineering, Cluj-Napoca, Romania.
Paul Serban
PS
Agachi
Department of Hepato-Gastroenterology, Purpan Hospital, CHU Toulouse, France.
Sophie
S
Metivier
Department of Hepato-Gastroenterology, Purpan Hospital, CHU Toulouse, France; INSERM U858, University of Toulouse, Toulouse, France.
Jean Marie
JM
Peron
Department of Pathology, Purpan Hospital, CHU Toulouse, France.
Janick
J
Selves
Regional Institute of Gastroenterology and Hepatology "O Fodor", Gastroenterology Department, Cluj-Napoca, Romania.
Horia
H
Stefanescu
Hepatology, University Clinic for Visceral Surgery and Medicine, Berne-Inselspital, Switzerland.
Annalisa
A
Berzigotti
Department of Hepato-Gastroenterology, Purpan Hospital, CHU Toulouse, France; INSERM U858, University of Toulouse, Toulouse, France.
Jean Pierre
JP
Vinel
Department of Hepato-Gastroenterology, Purpan Hospital, CHU Toulouse, France; INSERM U858, University of Toulouse, Toulouse, France.
Christophe
C
Bureau
D000368:Aged; D000465:Algorithms; D054459:Elasticity Imaging Techniques / Q000379:methods; D004932:Esophageal and Gastric Varices / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D008099:Liver / Q000378:metabolism* / Q000473:pathology*; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D016571:Neural Networks, Computer; D010976:Platelet Count
HVPG; Liver biopsy; Non-invasive tests; Oesophageal varices; Serological scores; Transient elastography