Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2017; 23(4): 687-696
Published online Jan 28, 2017. doi: 10.3748/wjg.v23.i4.687
Correlation of transient elastography with hepatic venous pressure gradient in patients with cirrhotic portal hypertension: A study of 326 patients from India
Ashish Kumar, Noor Muhammad Khan, Shrihari Anil Anikhindi, Praveen Sharma, Naresh Bansal, Vikas Singla, Anil Arora
Ashish Kumar, Noor Muhammad Khan, Shrihari Anil Anikhindi, Praveen Sharma, Naresh Bansal, Vikas Singla, Anil Arora, Institute of Liver, Gastroenterology, and Pancreatico-Biliary Sciences, Ganga Ram Institute for Postgraduate Medical Education and Research, Sir Ganga Ram Hospital, New Delhi 110060, India
Author contributions: Kumar A designed and performed the research, performed statistical analysis and wrote the paper; Khan NM collected the data; Anikhindi SA contributed to the analysis; Sharma P, Bansal N, Singla V provided clinical advice; Arora A supervised the study.
Institutional review board statement: This retrospective study was submitted to the Ethics Committee of Sir Ganga Ram Hospital, New Delhi for review.
Informed consent statement: Informed consent from the included patients was not obtained because the study was retrospective, and only anonymous clinical data of the patients were obtained retrospectively from the records. The data were anonymous, and the identities of patients were not disclosed. Each patient provided written informed consent for undergoing hepatic venous pressure gradient (HVPG).
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ashish Kumar, MBBS, MD, DM, Associate Professor, Institute of Liver, Gastroenterology, and Pancreatico-Biliary Sciences, Ganga Ram Institute for Postgraduate Medical Education and Research, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi 110060, India. ashishk10@yahoo.com
Telephone: +91-9312792573 Fax: +91-11-25861002
Received: September 11, 2016
Peer-review started: September 12, 2016
First decision: October 10, 2016
Revised: November 15, 2016
Accepted: January 2, 2017
Article in press: January 3, 2017
Published online: January 28, 2017
Abstract
AIM

To study the diagnostic accuracy of transient elastography (TE) for detecting clinically significant portal hypertension (CSPH) in Indian patients with cirrhotic portal hypertension.

METHODS

This retrospective study was conducted at the Institute of Liver, Gastroenterology, and Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, on consecutive patients with cirrhosis greater than 15 years of age who underwent hepatic venous pressure gradient (HVPG) and TE from July 2011 to May 2016. Correlation between HVPG and TE was analyzed using the Spearman’s correlation test. Receiver operating characteristic (ROC) curves were prepared for determining the utility of TE in predicting various stages of portal hypertension. The best cut-off value of TE for the diagnosis of CSPH was obtained using the Youden index.

RESULTS

The study included 326 patients [median age 52 (range 16-90) years; 81% males]. The most common etiology of cirrhosis was cryptogenic (45%) followed by alcohol (34%). The median HVPG was 16.0 (range 1.5 to 30.5) mmHg. Eighty-five percent of patients had CSPH. A significant positive correlation was noted between TE and HVPG (rho 0.361, P < 0.001). The area under ROC curve for TE in predicting CSPH was 0.740 (95%CI: 0.662-0.818) (P < 0.01). A cut-off value of TE of 21.6 kPa best predicted CSPH with a positive predictive value (PPV) of 93%.

CONCLUSION

TE has a fair positive correlation with HVPG; thus, TE can be used as a non-invasive modality to assess the degree of portal hypertension. A cut-off TE value of 21.6 kPa identifies CSPH with a PPV of 93%.

Keywords: Portal hypertension, Cirrhosis, Clinically significant portal hypertension, Liver stiffness, Transient elastography, FibroScan

Core tip: Clinically significant portal hypertension (CSPH), which is defined as hepatic venous pressure gradient (HVPG) ≥ 10 mmHg, causes major complications of cirrhosis. HVPG is invasive, so a non-invasive tool to diagnose CSPH is needed. This study of 326 Indian patients tested the diagnostic accuracy of transient elastography (TE) for detecting CSPH. We observed a significant positive correlation between TE and HVPG (rho 0.361, P < 0.001). The area under the receiver operating characteristic curve for TE in predicting CSPH was 0.740. A cut-off value of TE of 21.6 kPa best predicted CSPH with a positive predictive value of 93%. Thus, TE can be used as a non-invasive modality to assess the degree of portal hypertension.