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Noninvasive Diagnosis of Portal Hypertension in Patients With Compensated Advanced Chronic Liver Disease
Open accessAbstract
INTRODUCTION: We aimed to explore the prevalence of portal hypertension in the most common etiologies of patients with compensated advanced chronic liver disease (cACLD) and develop classification rules, based on liver stiffness measurement (LSM), that could be readily used to diagnose or exclude clinically significant portal hypertension (CSPH) in clinical practice. METHODS: This is an international cohort study including patients with paired LSM/hepatic venous pressure gradient (HVPG), LSM ≥10 kPa, and no previous decompensation. Portal hypertension was defined by an HVPG >5 mm Hg. A positive predictive value ≥90% was considered to validate LSM cutoffs for CSPH (HVPG ≥10 mm Hg), whereas a negative predictive value ≥90% ruled out CSPH. RESULTS: A total of 836 patients with hepatitis C (n = 358), nonalcoholic steatohepatitis (NASH, n = 248), alcohol use (n = 203), and hepatitis B (n = 27) were evaluated. Portal hypertension prevalence was >90% in all cACLD etiologies, except for patients with NASH (60.9%), being even lower in obese patients with NASH (53.3%); these lower prevalences of portal hypertension in patients with NASH were maintained across different strata of LSM values. LSM ≥25 kPa was the best cutoff to rule in CSPH in alcoholic liver disease, chronic hepatitis B, chronic hepatitis C, and nonobese patients with NASH, whereas in obese NASH patients, the positive predictive value was only 62.8%. A new model for patients with NASH (ANTICIPATE-NASH model) to predict CSPH considering body mass index, LSM, and platelet count was developed, and a nomogram was constructed. LSM ≤15 kPa plus platelets ≥150 × 10/L ruled out CSPH in most etiologies. DISCUSSION: Patients with cACLD of NASH etiology, especially obese patients with NASH, present lower prevalences of portal hypertension compared with other cACLD etiologies. LSM ≥25 kPa is sufficient to rule in CSPH in most etiologies, including nonobese patients with NASH, but not in obese patients with NASH.
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“The ANTICIPATE-NASH model, a function of LSM, platelet count and BMI, may help in assessing the risk of CSPH and liver-related events in individuals with compensated MASH-related cirrhosis and guide shared decision making on endoscopic surveillance 475”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [475]
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Expanding consensus in portal hypertension
de Franchis, R. (2015) · Journal of Hepatology · doi:10.1016/j.jhep.2015.05.022 · Cited by 3,078
Eddowes, P. J., Sasso, M., Allison, M., Tsochatzis, E. A., Anstee, Q. M., Sheridan, D. A., Guha, I. N., Cobbold, J., Deeks, J. J., Paradis, V., et al. (2019) · Gastroenterology · doi:10.1053/j.gastro.2019.01.042 · Cited by 1,425
Self-citationThe clinical use of HVPG measurements in chronic liver disease
Bosch, J., Abraldeṣ, J. G., Berzigotti, A., & García‐Pagán, J. C. (2009) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/nrgastro.2009.149 · Cited by 732
Self-citationVillanueva, C., Albillos, A., Genescà, J., Garcia-Pagan, J. C., Calleja, J. L., Aracil, C., Bañares, R., Morillas, R. M., Poca, M., Peñas, B., et al. (2019) · The Lancet · doi:10.1016/s0140-6736(18)31875-0 · Cited by 711
Self-citationSiddiqui, M. S., Vuppalanchi, R., Natta, M. L. V., Hallinan, E., Kowdley, K. V., Abdelmalek, M. F., Neuschwander‐Tetri, B. A., Loomba, R. S., Dasarathy, S., Brandman, D., et al. (2018) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2018.04.043 · Cited by 618
Berzigotti, A., Seijó, S., Arena, U., et al. (2012) · Gastroenterology · doi:10.1053/j.gastro.2012.10.001 · Cited by 541
Self-citationAbraldeṣ, J. G., Bureau, C., Ştefănescu, H., Augustín, S., Ney, M., Blasco, H., Procopeț, B., Bosch, J., Genescà, J., Berzigotti, A., et al. (2016) · Hepatology · doi:10.1002/hep.28824 · Cited by 391
Self-citationBureau, C., Métivier, S., Péron, J. M., Sèlves, J., Robic, M. A., Gourraud, P., Rouquet, O., DUPUIS, E., Alric, L., & Vinel, J. P. (2008) · Alimentary Pharmacology & Therapeutics · doi:10.1111/j.1365-2036.2008.03701.x · Cited by 362
Self-citationAustin, P. C., & Steyerberg, E. W. (2014) · Statistics in Medicine · doi:10.1002/sim.5941 · Cited by 362
Robic, M. A., Procopeț, B., Métivier, S., Péron, J. M., Sèlves, J., Vinel, J., & Bureau, C. (2011) · Journal of Hepatology · doi:10.1016/j.jhep.2011.01.051 · Cited by 307
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Rinella, M. E., Neuschwander-Tetri, B. A., Siddiqui, M. S., Abdelmalek, M. F., Caldwell, S., Barb, D., Kleiner, D. E., & Loomba, R. (2023) · Hepatology · doi:10.1097/hep.0000000000000323 · Cited by 2,667
Tacke, F., Horn, P., Wai-Sun Wong, V., Ratziu, V., Bugianesi, E., Francque, S., Zelber-Sagi, S., Valenti, L., Roden, M., Schick, F., et al. (2024) · Journal of Hepatology · doi:10.1016/j.jhep.2024.04.031 · Cited by 2,210
Wattacheril, J. J., Abdelmalek, M. F., Lim, J. K., & Sanyal, A. J. (2023) · Gastroenterology · doi:10.1053/j.gastro.2023.06.013 · Cited by 236
Dajti, E., Ravaioli, F., Zykus, R., Rautou, P.-E., Elkrief, L., Grgurevic, I., Stefanescu, H., Hirooka, M., Fraquelli, M., Rosselli, M., et al. (2023) · The Lancet Gastroenterology & Hepatology · doi:10.1016/s2468-1253(23)00150-4 · Cited by 109
Self-citationPrimavesi, F., Maglione, M., Cipriani, F., Denecke, T., Oberkofler, C. E., Starlinger, P., Dasari, B. V. M., Heil, J., Sgarbura, O., Søreide, K., et al. (2023) · British Journal of Surgery · doi:10.1093/bjs/znad233 · Cited by 97
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Metadata
- Authors
- Pons, M., Augustin, S., Scheiner, B., Guillaume, M., Rosselli, M., Rodrigues, S. G., Stefanescu, H., Ma, M. M., Mandorfer, M., Mergeay-Fabre, M., Procopet, B., Schwabl, P., Ferlitsch, A., Semmler, G., Berzigotti, A., Tsochatzis, E., Bureau, C., Reiberger, T., Bosch, J., Abraldes, J. G., & Genescà, J.
- Affiliations
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain;
- Medical University of Vienna (AT)
- Service d'Hépatologie CHU Toulouse Rangueil, Institut Cardiomet et Université Paul Sabatier, Toulouse, France;
- The Royal Free Hospital (GB)
- University of Bern (CH)
- Liver Unit, Regional Institute of Gastroenterology and Hepatology “Octavian Fodor,” University of Medicine and Pharmacy “Iuliu Hatieganu,” Cluj-Napoca, Romania;
- University of Alberta (CA)
- Université Toulouse III - Paul Sabatier (FR)
- Hospital of the Brothers of St. John of God (AT)
- Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Canada;
- Universitat Autònoma de Barcelona (ES)
- Corresponding author
- Genescà, Joan
- ORCID
- Venue
- American Journal of Gastroenterology
- Published
- 2020-10-08
- Volume
- 116
- Issue
- 4
- Pages
- 723-732
- ISSN
- 0002-9270 (ISSN-L)
- 1572-0241
- OpenAlex
- W3092352032
- Cited by
- 260
- References
- 27
- Citations by year
- 2026: 39 · 2025: 55 · 2024: 58 · 2023: 48 · 2022: 42 · 2021: 17 · 2020: 1
- FWCI
- 15.87
- Type
- journal article
- Language
- en
- Open access
- green
- discovery.ucl.ac.uk
- Locations
- The American Journal of Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- HAL (submittedVersion)
- Bern Open Repository and Information System (University of Bern) (submittedVersion)
- Funders
- Instituto de Salud Carlos III (PI17/00310, PI18/00947)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Health Sciences › Medicine › Hepatology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
- Keywords
- portal hypertension, compensated advanced chronic liver disease, liver stiffness measurement, hepatic venous pressure gradient, nonalcoholic steatohepatitis, obesity, hepatitis C, alcoholic liver disease, chronic hepatitis B, nomogram, platelet count, non-invasive diagnosis, prevalence
- MeSH terms
- Aged, Female, Humans, Hypertension, Portal, Liver, Liver Cirrhosis, Male, Middle Aged, Predictive Value of Tests, Severity of Illness Index, Portal Pressure, Elasticity Imaging Techniques
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