Abdominal Radiology

, Volume 42, Issue 11, pp 2609–2614 | Cite as

Hepatic venous pressure gradient correlates with advanced hepatic fibrosis: a retrospective review

  • Jonathan K. Vincent
  • Christopher Stark
  • Joseph T. Shields
  • Anant D. Bhave
  • Christopher S. MorrisEmail author



To determine if hepatic venous pressure gradient (HVPG) correlates with advanced hepatic fibrosis, as a complement to transjugular (transvenous) core needle liver biopsy.

Materials and methods

After institutional review board approval, a retrospective review was conducted on 340 patients who underwent transjugular (transvenous) core needle liver biopsy with concurrent pressure measurements between 6/1/2007 and 6/1/2013. Spearman correlation and linear regression were performed. A receiver operating characteristic (ROC) curve was created and sensitivity, specificity, predictive values and likelihood ratios were calculated.


Indications included hepatitis C, abnormal liver function tests, non-alcoholic steatohepatitis, autoimmune hepatitis, and cirrhosis, among others. Biopsies showed stage 1 or 2 fibrosis in 15.6% each, stage 3 fibrosis in 21.6%, stage 4 fibrosis in 40.7%, and no fibrosis in 6.5%. Mean HVPG was 6.5 mm Hg (SD 5.0) with a range of 0–26 mm Hg. Spearman correlation coefficient for association between HVPG and fibrosis stage was 0.561 (p < 0.001). R2 on linear regression was 0.247 (p < 0.001). ROC curve for the prediction of stage 4 fibrosis had an area under the curve of 0.79 (95% CI 0.73–0.85). HVPG of ≥6 mm Hg had a sensitivity of 71.3%, specificity of 79.6%, positive predictive value of 70.5%, negative predictive value of 80.2%, positive likelihood ratio of 3.49 (95% CI 2.45–4.97) and negative likelihood ratio of 0.36 (95% CI 0.26–0.50) for diagnosis of stage 4 fibrosis.


HVPG correlates with stage 4 (advanced) hepatic fibrosis.


Biopsy Transjugular Liver Wedge Pressure Fibrosis 



We thank Aida Arapovic for her assistance with and coordination of institutional review board approval, as well as Richard Watts, PhD for his statistical advice. We also thank James deKay, MD for his assistance in obtaining pathology slides.

Compliance with ethical standards


No funding was received for this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Informed consent

Statement of informed consent was not applicable since the manuscript does not contain any patient data.


  1. 1.
    American Liver Foundation (2013) Liver disease: the big picture. Accessed 22 August 2016
  2. 2.
    Centers for Disease Control and Prevention (2016) Chronic liver disease and cirrhosis. Accessed 22 August 2016
  3. 3.
    Afdhal NH, Nunes D (2004) Evaluation of liver fibrosis: a concise review. Am J Gastroenterol 99:1160–1174CrossRefPubMedGoogle Scholar
  4. 4.
    Kumar M, Kumar A, Hissar S, et al. (2008) Hepatic venous pressure gradient as a predictor of fibrosis in chronic liver disease because of hepatitis B virus. Liver Int 28:690–698CrossRefPubMedGoogle Scholar
  5. 5.
    Kim MY, Jeong WK, Baik SK (2014) Invasive and non-invasive diagnosis of cirrhosis and portal hypertension. World J Gastroenterol 20:4300–4315CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Armonis A, Patch D, Burroughs A (1997) Hepatic venous pressure measurement: an old test as a new prognostic marker in cirrhosis? Hepatology 25:245–248CrossRefPubMedGoogle Scholar
  7. 7.
    Ripoll C (2007) Hepatic venous pressure gradient and outcomes in cirrhosis. J Clin Gastroenterol 41:S330–S335CrossRefPubMedGoogle Scholar
  8. 8.
    Garcia-Tsao G, Friedman S, Iredale J, Pinzani M (2010) Now there are many (stages) where before there was one: in search of a pathophysiological classification of cirrhosis. Hepatology 51:1445–1449CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Albillos A, Garcia-Tsao G (2011) Classification of cirrhosis: the clinical use of HVPG measurements. Dis Markers 31:121–128CrossRefGoogle Scholar
  10. 10.
    Albillos A, Banares R, Gonzalez M, et al. (2007) Value of the hepatic venous pressure gradient to monitor drug therapy for portal hypertension: a meta-analysis. Am J Gastroenterol 102:1116–1126CrossRefPubMedGoogle Scholar
  11. 11.
    Stanley AJ, Robinson I, Forrest EH, Jones AL, Hayes PC (1998) Haemodynamic parameters predicting variceal haemorrhage and survival in alcoholic cirrhosis. QJM 91:19–25CrossRefPubMedGoogle Scholar
  12. 12.
    Vorobioff J, Groszmann RJ, Picabea E, et al. (1996) Prognostic value of hepatic venous pressure gradient measurements in alcoholic cirrhosis: a 10-year prospective study. Gastroenterology 111:701–709CrossRefPubMedGoogle Scholar
  13. 13.
    Viallet A, Marleau D, Huet M, et al. (1975) Hemodynamic evaluation of patients with intrahepatic portal hypertension: relationship between bleeding varices and the portohepatic gradient. Gastroenterology 69:1297–1300PubMedGoogle Scholar
  14. 14.
    Groszmann RJ, Bosch J, Grace ND, et al. (1990) Hemodynamic events in a prospective randomized trial of propranolol versus placebo in the prevention of a first variceal hemorrhage. Gastroenterology 99:1401–1407CrossRefPubMedGoogle Scholar
  15. 15.
    Ripoll C, Bañares R, Rincón D, et al. (2005) Influence of hepatic venous pressure gradient on the prediction of survival of patients with cirrhosis in the MELD era. Hepatology 42:793–801CrossRefPubMedGoogle Scholar
  16. 16.
    Garcia-Tsao G, Groszmann RJ, Fisher RL, et al. (1985) Portal pressure, presence of gastroesophageal varices and variceal bleeding. Hepatology 5:419–424CrossRefPubMedGoogle Scholar
  17. 17.
    Myers JD, Taylor WJ (1951) An estimation of portal venous pressure by occlusive catheterization of a hepatic venule. J Clin Investig 30:662–663Google Scholar
  18. 18.
    Kumar A, Sharma P, Sarin SK (2008) Hepatic venous pressure gradient measurement: time to learn!. Indian J Gastroenterol 27:74–80PubMedGoogle Scholar
  19. 19.
    Suk KT (2014) Hepatic venous pressure gradient: clinical use in chronic liver disease. Clin Mol Hepatol 20:6–14CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Wolf AT, Maurer R, Glickman J, Grace ND (2008) Hepatic venous pressure gradient supplements liver biopsy in the diagnosis of cirrhosis. J Clin Gastroenterol 42:199–203CrossRefPubMedGoogle Scholar
  21. 21.
    Rastogi A, Maiwall R, Bihari C, et al. (2013) Cirrhosis histology and Laennec staging system correlate with high portal pressure. Histopathology 62:731–741CrossRefPubMedGoogle Scholar
  22. 22.
    Picchiotti R, Mingazzini PL, Scucchi L, et al. (1994) Correlations between sinusoidal pressure and liver morphology in cirrhosis. J Hepatol 20:364–369CrossRefPubMedGoogle Scholar
  23. 23.
    Nagula S, Jain D, Groszmann RJ, Garcia-Tsao G (2006) Histological-hemodynamic correlation in cirrhosis – a histological classification of the severity of cirrhosis. J Hepatol 44:111–117CrossRefPubMedGoogle Scholar
  24. 24.
    Blasco A, Forns X, Carrión JA, et al. (2006) Hepatic venous pressure gradient identifies patients at risk of severe hepatitis C recurrence after liver transplantation. Hepatology 43:492–499CrossRefPubMedGoogle Scholar
  25. 25.
    Stremitzer S, Tamandl D, Kaczirek K, et al. (2011) Value of hepatic venous pressure gradient measurement before liver resection for hepatocellular carcinoma. Br J Surg 98:1752–1758CrossRefPubMedGoogle Scholar
  26. 26.
    Kim MY, Cho MY, Baik SK, et al. (2011) Histological subclassification of cirrhosis using the Laennec fibrosis scoring system correlates with clinical stage and grade of portal hypertension. J Hepatol 55:1004–1009CrossRefPubMedGoogle Scholar
  27. 27.
    Kumar M, Sakhuja P, Kumar A, et al. (2008) Histological subclassification of cirrhosis based on histological-hemodynamic correlation. Aliment Pharmacol Ther 27:771–779CrossRefPubMedGoogle Scholar
  28. 28.
    Sarin SK, Bhatia V, Wu JCY, Sung JJY (2010) Upper gastrointestinal bleeding disorders. In: Classen M, Tytgat GNJ, Lightdale CJ (eds) Gastroenterological endoscopy. New York: Thieme, pp 577–594Google Scholar
  29. 29.
    Bosch J, Abraldes JG, Berzigotti A, García-Pagan JC (2009) The clinical use of HVPG measurements in chronic liver disease. Nat Rev Gastroenterol Hepatol 6:573–582CrossRefPubMedGoogle Scholar
  30. 30.
    Ripoll C, Groszmann R, Garcia-Tsao G, et al. (2007) Hepatic venous pressure gradient predicts clinical decompensation in patients with compensated cirrhosis. Gastroenterology 133:481–488CrossRefPubMedGoogle Scholar
  31. 31.
    Kim MY, Baik SK, Suk KT, et al. (2008) Measurement of hepatic venous pressure gradient in liver cirrhosis: relationship with the status of cirrhosis, varices and ascites in Korea. Korean J Hepatol 14:150–158CrossRefPubMedGoogle Scholar
  32. 32.
    Groszmann RJ, Garcia-Tsao G, Bosch J, et al. (2005) Beta-blockers to prevent gastroesophageal varices in patients with cirrhosis. N Engl J Med 353:2254–2261CrossRefPubMedGoogle Scholar
  33. 33.
    Ripoll C, Groszmann RJ, Garcia-Tsao G, et al. (2009) Hepatic venous pressure gradient predicts development of hepatocellular carcinoma independently of severity of cirrhosis. J Hepatol 50:923–928CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Bruix J, Castells A, Bosch J, et al. (1996) Surgical resection of hepatocellular carcinoma in cirrhotic patients: prognostic value of preoperative portal pressure. Gastroenterology 111:1018–1022CrossRefPubMedGoogle Scholar
  35. 35.
    D’Amico G, Garcia-Pagan JC, Luca A, Bosch J (2006) Hepatic vein pressure gradient reduction and prevention of variceal bleeding in cirrhosis: a systematic review. Gastroenterology 131:1611–1624CrossRefPubMedGoogle Scholar
  36. 36.
    Feu F, García-Pagán JC, Bosch J, et al. (1995) Relation between portal pressure response to pharmacotherapy and risk of recurrent variceal haemorrhage in patients with cirrhosis. Lancet 346:1056–1059CrossRefPubMedGoogle Scholar
  37. 37.
    Hytiroglou P, Snover DC, Alves V, et al. (2012) Beyond “cirrhosis”: a proposal from the International Liver Pathology Study Group. Am J Clin Pathol 137:5–9CrossRefPubMedGoogle Scholar
  38. 38.
    van Leeuwen DJ, Howe SC, Scheuer PJ, Sherlock S (1990) Portal hypertension in chronic hepatitis: relationship to morphological changes. Gut 31:339–343CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Siddique I, El-Naga HA, Madda JP, Memon A, Hasan F (2003) Sampling variability on percutaneous liver biopsy in patients with chronic hepatitis C virus infection. Scand J Gastroenterol 38:427–432CrossRefPubMedGoogle Scholar
  40. 40.
    Maleux G, Willems E, Fieuws S, et al. (2011) Prospective study comparing different indirect methods to measure portal pressure. J Vasc Interv Radiol 22:1553–1558CrossRefPubMedGoogle Scholar
  41. 41.
    Silva-Junior G, Baiges A, Turon F, et al. (2015) The prognostic value of hepatic venous pressure gradient in patients with cirrhosis is highly dependent on the accuracy of the technique. Hepatology 62:1584–1592CrossRefPubMedGoogle Scholar
  42. 42.
    Thalheimer U, Bellis L, Puoti C, Burroughs AK (2011) Should we routinely measure portal pressure in patients with cirrhosis, using hepatic venous pressure gradient (HVPG) as a guide for prophylaxis and therapy of bleeding and rebleeding? No. Eur J Intern Med 22:5–7CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Jonathan K. Vincent
    • 1
  • Christopher Stark
    • 2
  • Joseph T. Shields
    • 3
  • Anant D. Bhave
    • 3
  • Christopher S. Morris
    • 3
    • 4
    Email author
  1. 1.Department of RadiologyBeth Israel Deaconess Plymouth HospitalPlymouthUSA
  2. 2.Department of RadiologyAlbany Medical CenterAlbanyUSA
  3. 3.Department of RadiologyLarner College of Medicine at the University of VermontBurlingtonUSA
  4. 4.Patrick 1 RadiologyUniversity of Vermont Medical CenterBurlingtonUSA

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