title: The macrophage activation marker sCD163 combined with markers of the Enhanced Liver Fibrosis (ELF) score predicts clinically significant portal hypertension in patients with cirrhosis.
abstract: Noninvasive identification of significant portal hypertension in patients with cirrhosis is needed in hepatology practice.
  
  
  
  To investigate whether the combination of sCD163 as a hepatic inflammation marker and the fibrosis markers of the Enhanced Liver Fibrosis score (ELF) can predict portal hypertension in patients with cirrhosis.
  
  
  
  We measured sCD163 and the ELF components (hyaluronic acid, tissue inhibitor of metalloproteinase-1 and procollagen-III aminopeptide) in two separate cohorts of cirrhosis patients that underwent hepatic vein catheterisation. To test the predictive accuracy we developed a CD163-fibrosis portal hypertension score in an estimation cohort (n = 80) and validated the score in an independent cohort (n = 80). A HVPG ≥10 mmHg was considered clinically significant.
  
  
  
  Both sCD163 and the ELF components increased in a stepwise manner with the patients' Child-Pugh score (P < 0.001, all), and also with increasing HVPG (P < 0.001). receiver operator characteristics (ROC) analyses showed that each one of the individual components predicted a HVPG >10 mmHg with AUROC's of approximately 0.80. The combined score optimised by logistic regression analyses improved the AUROC to 0.91 in the estimation cohort and 0.90 in the validation cohort. Furthermore, a high value of the combined score was associated with a high short-term mortality.
  
  
  
  The combination of the macrophage activation marker sCD163 and the fibrosis markers predicted significant portal hypertension in patients with cirrhosis. This score may prove useful for screening purposes and highlights the importance of both the inflammatory and the fibrotic components of cirrhotic portal hypertension.
authors.affiliation: Department of Hepatology & Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: T D
authors.initials: TD
authors.lastname: Sandahl
authors.affiliation: Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: R
authors.initials: R
authors.lastname: McGrail
authors.affiliation: Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: H J
authors.initials: HJ
authors.lastname: Møller
authors.affiliation: Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Barcelona, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Reverter
authors.affiliation: Department of Clinical Physiology and Nuclear Medicine, 239 Center for Functional and Diagnostic Imaging and Research, Faculty of Health Sciences Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark.
authors.forename: S
authors.initials: S
authors.lastname: Møller
authors.affiliation: Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Barcelona, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Turon
authors.affiliation: Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Barcelona, Spain.
authors.forename: V
authors.initials: V
authors.lastname: Hernández-Gea
authors.affiliation: Gastroenterology Unit, Medical Section, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark.
authors.forename: F
authors.initials: F
authors.lastname: Bendtsen
authors.affiliation: Department of Hepatology & Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: H
authors.initials: H
authors.lastname: Vilstrup
authors.affiliation: Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Barcelona, Spain.
authors.forename: J C
authors.initials: JC
authors.lastname: Garcia-Pagan
authors.affiliation: Department of Hepatology & Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: H
authors.initials: H
authors.lastname: Grønbaek
mesh_terms: D000368:Aged; D015415:Biomarkers; D003430:Cross-Sectional Studies; D005260:Female; D006503:Hepatic Veins / Q000503:physiopathology; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000503:physiopathology*; D008103:Liver Cirrhosis / Q000150:complications / Q000503:physiopathology*; D008262:Macrophage Activation; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D019715:Tissue Inhibitor of Metalloproteinase-1 / Q000378:metabolism
chemical_list: D015415:Biomarkers; D019715:Tissue Inhibitor of Metalloproteinase-1