Transient Elastography as Non Invasive Assessment of Portal Hypertension in Advanced Chronic Liver Disease

Abstract

Background: Hepatic cirrhosis (HC) is the most frequent source of clinically significant portal hypertension (CSPH) in Western countries. A reliable, easy-to-use, and noninvasive tool to assess for the presence of CSPH for screening of cirrhotic patients is needed. Aims: 1) To determine the correlation between liver stiffness (LS), measured by transient elastography (TE) and portal hypertension (PH), by hepatic venous pressure gradient(HVPG), as well as the cut off value of TE for CSPH; 2) To evaluate the correlation between CSPH and LS with the histological findings in liver biopsy; 3) To assess the relationship between the degree of LS and the risk of clinical decompensation in HC. Methods: Single center, prospective, cohort study. 58 in-and-out-patients with chronic liver diseases were enrolled during a 40-month period. Results: A statistically significant association between LS (TE), and PH (HVPG) was found (r = 0.71, p < 0.0001). Cut off value of TE for diagnosis of CSPH was 17.15 kPa. Using this cut-off, 81% of the patients presented CSPH while 87% using the HVPG cut-off of ≥10mmHg. Both the nodule size and septal thickening were the two independent predictors of CSPH. The probability of remaining free of developing a hepatic decompensation was significantly superior in the group of patients without CSPH (TE < 17.15 kPa, p < 0.001). Conclusions:TE is a reliable, non-invasive and affordable tool for assessing CSPH. A statistically significant association between LS measured by TE and HVPG as prognostic tool for development of CSPH in patients with chronic liver diseas