title: Stage of fibrosis and portal pressure correlation in nonalcoholic steatohepatitis.
abstract: BACKGROUND
  Hepatic venous pressure gradient (HVPG) measurement correlates with staging of liver fibrosis. Patients with nonalcoholic steatohepatitis (NASH) have a different pattern of fibrosis compared with hepatitis C virus (HCV) with possible alterations in pressures.
  
  
  OBJECTIVE
  The aim of this study was to compare portal pressures with the stage of fibrosis in NASH in comparison with other liver diseases.
  
  
  METHODS
  Records of all patients who had undergone transjugular liver biopsy with pressure measurements between January 2001 and June 2013 were reviewed. Wedge hepatic venous pressure (WHVP) and HVPG were compared with stages of fibrosis in liver diseases of different etiologies.
  
  
  RESULTS
  Among 142 patients included in this study, the liver disease etiology was as follows: HCV (26.6%) and NASH (24.6%), with the remaining (38.7%) grouped under other categories. The mean age of the patients was 51.2±11.5 years, with more men with HCV (73.1%) compared with NASH (51.4%) in terms of etiology (P=0.046). There were strong correlations between the stage of fibrosis with both the HVPG (r=0.64; P<0.0001) and the WHVP (r=0.63; P<0.0001) in NASH patients. Compared with HCV patients, NASH patients had a lower HVPG (3.4±2.4 vs. 7.5±11 mmHg/stage; P=0.01) with a coefficient estimate of -0.24 (P=0.017) and WHVP (9.6±5.5 vs. 14.6±15.2 mmHg/stage; P=0.03) for the stage of fibrosis.
  
  
  CONCLUSIONS
  HVPG and WHVP measurements were strongly correlated with stages of fibrosis in NASH. Patients with NASH had lower HVPG and WHVP for each stage of fibrosis compared with HCV patients. This raises the concern of underestimation of pressures by HVPG in NASH etiology for the stage of disease or increased fibrosis despite lower pressures in them.
authors.affiliation: aDivision of Gastroenterology, Hepatology and NutritionbDepartment of Transplant Surgery, University of Pittsburgh Medical Center, Pittsburgh, PennsylvaniacDivision of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WisconsindDepartment of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic FoundationeCleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Achuthan
authors.initials: A
authors.lastname: Sourianarayanane
authors.forename: Jyothsna
authors.initials: J
authors.lastname: Talluri
authors.forename: Abinav
authors.initials: A
authors.lastname: Humar
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: McCullough
mesh_terms: D000328:Adult; D001706:Biopsy; D005260:Female; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D017082:Portal Pressure / Q000502:physiology*; D012720:Severity of Illness Index