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Limited diagnostic value of liver stiffness for clinically significant portal hypertension in HBV-related cirrhosis

  • Hepatobiliary
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

Hepatic venous pressure gradient (HVPG) is the gold standard for portal pressure in cirrhosis, but most previous studies focused on the diagnostic value of clinically significant portal hypertension (CSPH) based on the correlation between liver stiffness (LS) and HVPG in hepatitis C virus (HCV) patients and alcoholic liver. Therefore, it is necessary to clarify the diagnostic value of LS for CSPH and the correlation with HVPG in hepatitis B virus (HBV) patients.

Methods

A total of 137 patients from the Fifth Medical Center of PLA General Hospital were divided into HBV group and non-HBV group according to etiology. Correlation analysis and ROC were used to analyze the correlation between LS and HVPG and the diagnostic value of CSPH.

Results

There was a good correlation between LS and HVPG in the total cohort and non-HBV cohort (r = 0.398, P < 0.001; r = 0.575, P < 0.001, respectively). However, the correlation between LS and HVPG was acceptable in the HBV cohort (r = 0.316, P = 0.002). When adjustment for age, MELD score, and INR, the result was still the same. Similar results were observed in the prediction for CSPH. LS showed good diagnostic value for CSPH in the total cohort and non-HBV cohort (AUC = 0.732, AUC = 0.829, respectively). However, it performed poorly in the HBV cohort (AUC = 0.689).

Conclusion

The etiology of HBV might affect the diagnostic performance of LS for predicting CSPH.

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References

  1. Garcia-Tsao G, Friedman S, Iredale J, Pinzani M. Now there are many (stages) where before there was one: In search of a pathophysiological classification of cirrhosis. Hepatology. 2010 Apr;51(4):1445-9. doi: https://doi.org/10.1002/hep.23478. PMID: 20077563; PMCID: PMC2882065.

    Article  PubMed  Google Scholar 

  2. Liang XE, Chen YP. Clinical Application of Vibration Controlled Transient Elastography in Patients with Chronic Hepatitis B. J Clin Transl Hepatol. 2017 Dec 28;5(4):368–375. doi: https://doi.org/10.14218/JCTH.2017.00006. Epub 2017 Jul 26. PMID: 29226103; PMCID: PMC5719194.

  3. Schwabl P, Bota S, Salzl P, Mandorfer M, Payer BA, Ferlitsch A, Stift J, Wrba F, Trauner M, Peck-Radosavljevic M, Reiberger T. New reliability criteria for transient elastography increase the number of accurate measurements for screening of cirrhosis and portal hypertension. Liver Int. 2015 Feb;35(2):381-90. doi: https://doi.org/10.1111/liv.12623. Epub 2014 Jul 9. PMID: 24953516.

    Article  PubMed  Google Scholar 

  4. Myers RP, Crotty P, Pomier-Layrargues G, Ma M, Urbanski SJ, Elkashab M. Prevalence, risk factors and causes of discordance in fibrosis staging by transient elastography and liver biopsy. Liver Int. 2010 Nov;30(10):1471-80. doi: https://doi.org/10.1111/j.1478-3231.2010.02331.x. Epub 2010 Aug 30. PMID: 20807336.

    Article  PubMed  Google Scholar 

  5. Garcia-Tsao G, et al. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases. Hepatology. 2017; 65: 310-335.

    Article  Google Scholar 

  6. de Franchis R, Baveno VI. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J Hepatol. 2015; 63: 743-752

    Article  Google Scholar 

  7. Llop E, Berzigotti A, Reig M, Erice E, Reverter E, Seijo S, Abraldes JG, Bruix J, Bosch J, García-Pagan JC. Assessment of portal hypertension by transient elastography in patients with compensated cirrhosis and potentially resectable liver tumors. J Hepatol. 2012 Jan;56(1):103-8. doi: https://doi.org/10.1016/j.jhep.2011.06.027. Epub 2011 Aug 7. PMID: 21827733.

    Article  PubMed  Google Scholar 

  8. Kitson MT, Roberts SK, Colman JC, Paul E, Button P, Kemp W. Liver stiffness and the prediction of clinically significant portal hypertension and portal hypertensive complications. Scand J Gastroenterol. 2015 Apr;50(4):462-9. doi: https://doi.org/10.3109/00365521.2014.964758. Epub 2015 Jan 26. PMID: 25623641.

    Article  PubMed  Google Scholar 

  9. You MW, Kim KW, Pyo J, Huh J, Kim HJ, Lee SJ, Park SH. A Meta-analysis for the Diagnostic Performance of Transient Elastography for Clinically Significant Portal Hypertension. Ultrasound Med Biol. 2017 Jan;43(1):59-68. doi: https://doi.org/10.1016/j.ultrasmedbio.2016.07.025. Epub 2016 Oct 15. PMID: 27751595.

    Article  PubMed  Google Scholar 

  10. Vuille-Lessard É, Rodrigues SG, Berzigotti A. Noninvasive Detection of Clinically Significant Portal Hypertension in Compensated Advanced Chronic Liver Disease. Clin Liver Dis. 2021 May;25(2):253-289. doi: https://doi.org/10.1016/j.cld.2021.01.005. PMID: 33838850.

    Article  PubMed  Google Scholar 

  11. Kumar A, Khan NM, Anikhindi SA, Sharma P, Bansal N, Singla V, Arora A. Correlation of transient elastography with hepatic venous pressure gradient in patients with cirrhotic portal hypertension: A study of 326 patients from India. World J Gastroenterol. 2017 Jan 28;23(4):687-696. doi: https://doi.org/10.3748/wjg.v23.i4.687. PMID: 28216976; PMCID: PMC5292343.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Zhu YL, Ding H, Fu TT, Peng SY, Chen SY, Luo JJ, Wang WP. Portal hypertension in hepatitis B-related cirrhosis: Diagnostic accuracy of liver and spleen stiffness by 2-D shear-wave elastography. Hepatol Res. 2019 May;49(5):540-549. doi: https://doi.org/10.1111/hepr.13306. Epub 2019 Jan 28. PMID: 30597744.

    Article  PubMed  Google Scholar 

  13. Okajima A, Sumida Y, Taketani H, Hara T, Seko Y, Ishiba H, et al. Liver stiffness measurement to platelet ratio index predicts the stage of liver fibrosis in non-alcoholic fatty liver disease. Hepatol Res 2017;47:721-730.

    Article  CAS  Google Scholar 

  14. Giannini E, Botta F, Borro P et al. Platelet count/spleen diameter ratio: proposal and validation of a non-invasive parameter to predict the presence of oesophageal varices in patients with liver cirrhosis. Gut. 2003 Aug;52(8):1200-5. doi: https://doi.org/10.1136/gut.52.8.1200. PMID: 12865282; PMCID: PMC1773759.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Sterling RK, Lissen E, Clumeck N, et al. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology. 2006 Jun;43(6):1317-25. doi: https://doi.org/10.1002/hep.21178. PMID: 16729309.

    Article  CAS  PubMed  Google Scholar 

  16. Kim BK, Han KH, Park JY et al. A liver stiffness measurement-based, noninvasive prediction model for high-risk esophageal varices in B-viral liver cirrhosis. Am J Gastroenterol 2010; 105:1382–90.

    Article  Google Scholar 

  17. Wai CT, Greenson JK, Fontana RJ, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology. 2003;38:518–26.

    Article  Google Scholar 

  18. Berzigotti A, Seijo S, Arena U et al. Elastography, spleen size, and platelet count identify portal hypertension in patients with compensated cirrhosis. Gastroenterology 2013; 144:102–10.

    Article  Google Scholar 

  19. Seo YS, Kim MY, Kim SU, et al. Accuracy of transient elastography in assessing liver fibrosis in chronic viral hepatitis: A multicentre, retrospective study. Liver Int 2015; 35: 2246-55.

    Article  CAS  Google Scholar 

  20. Ramanathan S, Khandelwal N, Kalra N, Bhatia A, Dhiman RK, Duseja AK, Chawla YK. Correlation of HVPG level with ctp score, MELD Score, ascites, size of varices, and etiology in cirrhotic patients. Saudi J Gastroenterol. 2016 Mar-Apr;22(2):109–15. doi: https://doi.org/10.4103/1319-3767.164185. PMID: 26997216; PMCID: PMC4817293.

  21. Kim BK. The cutoff of transient elastography for the evaluation of portal hypertension should be different according to the etiology? Clin Mol Hepatol. 2021 Jan;27(1):91–93. doi: https://doi.org/10.3350/cmh.2020.0311. Epub 2020 Dec 3. PMID: 33317235; PMCID: PMC7820203.

  22. Song J, Ma Z, Huang J, Liu S, Luo Y, Lu Q, Schwabl P, Zykus R, Kumar A, Kitson M. Comparison of three cut-offs to diagnose clinically significant portal hypertension by liver stiffness in chronic viral liver diseases: a meta-analysis. Eur Radiol. 2018 Dec;28(12):5221-5230. doi: https://doi.org/10.1007/s00330-018-5478-z. Epub 2018 Jun 1. PMID: 29858640.

    Article  PubMed  Google Scholar 

  23. Kumar M, Kumar A, Hissar S, Jain P, Rastogi A, Kumar D, Sakhuja P, Sarin SK. Hepatic venous pressure gradient as a predictor of fibrosis in chronic liver disease because of hepatitis B virus. Liver Int. 2008 May;28(5):690-8. doi: https://doi.org/10.1111/j.1478-3231.2008.01711.x. PMID: 18433395.

    Article  PubMed  Google Scholar 

  24. Stefanescu H, Rusu C, Lupsor-Platon M, Nicoara Farcau O, Fischer P, Grigoras C, Horhat A, Stancu O, Ardelean A, Tantau M, Badea R, Procopet B. Liver Stiffness Assessed by Ultrasound Shear Wave Elastography from General Electric Accurately Predicts Clinically Significant Portal Hypertension in Patients with Advanced Chronic Liver Disease. Ultraschall Med. 2020 Oct;41(5):526–533. English. doi: https://doi.org/10.1055/a-0965-0745. Epub 2019 Sep 2. PMID: 31476787.

  25. Hu X, Huang X, Hou J, Ding L, Su C, Meng F. Diagnostic accuracy of spleen stiffness to evaluate portal hypertension and esophageal varices in chronic liver disease: a systematic review and meta-analysis. Eur Radiol. 2021 Apr;31(4):2392–2404. doi: https://doi.org/10.1007/s00330-020-07223-8. Epub 2020 Sep 24. Erratum in: Eur Radiol. 2020 Nov 18;: PMID: 32974686; PMCID: PMC7979650.

  26. Tseng Y, Li F, Wang J, Chen S, Jiang W, Shen X, Wu S. Spleen and liver stiffness for noninvasive assessment of portal hypertension in cirrhotic patients with large esophageal varices. J Clin Ultrasound. 2018 Sep;46(7):442-449. doi: https://doi.org/10.1002/jcu.22635. Epub 2018 Aug 21. PMID: 30132919.

    Article  PubMed  Google Scholar 

  27. Takuma Y, Nouso K, Morimoto Y, Tomokuni J, Sahara A, Takabatake H, Matsueda K, Yamamoto H. Portal Hypertension in Patients with Liver Cirrhosis: Diagnostic Accuracy of Spleen Stiffness. Radiology. 2016 May;279(2):609-19. doi: https://doi.org/10.1148/radiol.2015150690. Epub 2015 Nov 20. PMID: 26588019.

    Article  PubMed  Google Scholar 

  28. Zykus R, Jonaitis L, Petrenkienė V, Pranculis A, Kupčinskas L. Liver and spleen transient elastography predicts portal hypertension in patients with chronic liver disease: a prospective cohort study. BMC Gastroenterol. 2015 Dec 24;15:183. doi: https://doi.org/10.1186/s12876-015-0414-z. Erratum in: BMC Gastroenterol. 2016;16(1):53. PMID: 26702818; PMCID: PMC4690243.

    Article  Google Scholar 

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Acknowledgements

We appreciate all the participants who supported this study.

Funding

The authors declared that this study has received no financial support.

Author information

Author notes

  1. Mengmeng Zhang and Xiaoxia Niu have contributed to this manuscript equally.

Authors and Affiliations

  1. Department of Radiology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China

    Mengmeng Zhang, Ruping Qi, Xuexin Qi, Jinghui Dong, Yuan Liu, Xu Bai, Changchun Liu & Jianming Cai

  2. Senior Department of Hepatology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China

    Xiaoxia Niu & Di Zhao

  3. Department of Interventional Radiology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China

    Qiang Yu

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Contributions

Concept—CL; Design –CL; Supervision—CL, JD; Resources—DZ, XN, QY; Materials—DZ, XN, QY; Data Collection and/or Processing—CL, MZ, XQ, RQ; Analysis and/or Interpretation—MZ, XB; Literature Search—MZ, YL; Writing of the Manuscript—MZ; Critical Review—JC.

Corresponding authors

Correspondence to Changchun Liu or Jianming Cai.

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Ethical approval

Ethics committee approval was received for this study from the Chinese PLA General Hospital Institutional Review Board (Decision date Oct 27, 2015. Decision number 2015146D).

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Informed consent is not necessary due to the retrospective nature of this study.

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Zhang, M., Niu, X., Zhao, D. et al. Limited diagnostic value of liver stiffness for clinically significant portal hypertension in HBV-related cirrhosis. Abdom Radiol 47, 3712–3723 (2022). https://doi.org/10.1007/s00261-022-03632-z

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