RISK PREDICTION OF PORTAL HYPERTENSION IN PATIENTS WITH HCV-ASSOCIATED LIVER CIRRHOSIS
Abstract
Background. The development of portal hypertension is a key aspect of natural disease course in HCV-associated liver cirrhosis. Although shear wave elastography has been validated for liver cirrhosis assessment, its role in the risk prediction of portal hypertension requires additional evaluation.Objective – to develop and estimate clinical prognostic model for portal hypertension risk assessment in patients with liver cirrhosis (HCV).
Materials and methods. A total of 388 patients were included in the study. Assessment of portal hypertension risk was based on logistic regression models. Odds ratios with 95% confidence intervals were calculated. External model validation was performed using testing data set.
Results. Two logistic regression models were developed: Model 1 included liver stiffness based on shear wave elastography only (κ = 0.106, AUC 56.0% (95% CI 47.8 – 64.3)); Model 2 included liver stiffness based on shear wave elastography, spleen length, platelets, and age (κ = 0.478, AUC 78.8% (95% CI 68.5 – 89.2)).
Conclusion. The combined use of additional predictors along with shear wave elastography has been shown to improve the prediction of portal hypertension in patients with HCV-associated liver cirrhosis.
References
1. Westbrook RH, Dusheiko G. Natural history of hepatitis C. J. Hepatol. 2014;61(1):S58-68. doi: 10.1016/j. jhep.2014.07.012.
2. Berzigotti A, Seijo S, Reverter E, Bosch J. Assessing portal hypertension in liver diseases. Expert Rev. Gastroenterol. Hepatol. 2013;7(2):141-155. doi: 10.1586/egh.12.83.
3. Ripoll C, Groszmann R, Garcia-Tsao G, Grace N, Burroughs A, Planas R, Escorsell A, Garcia-Pagan JC, Makuch R, Patch D, Matloff DS, Bosch J; Portal Hypertension Collaborative Group. Hepatic venous pressure gradient predicts clinical decompensation in patients with compensated cirrhosis. Gastroenterology. 2007;133(2):481-488. doi: 10.1053/j.gastro.2007.05.024.
4. Groszmann RJ, Garcia-Tsao G, Bosch J, Grace ND, Burroughs AK, Planas R, Escorsell A, Garcia-Pagan JC, Patch D, Matloff DS, Gao H, Makuch R; Portal Hypertension Collaborative Group. Beta-blockers to prevent gastroesophageal varices in patients with cirrhosis. N. Engl. J. Med. 2005;353(21):2254-2261. doi: 10.1056/NEJMoa044456
5. Silva-Junior G, Baiges A, Turon F, Torres F, Hernández- Gea V, Bosch J, García-Pagán JC. The prognostic value of hepatic venous pressure gradient in patients with cirrhosis is highly dependent on the accuracy of the technique. Hepatology. 2015;62(5):1584-1592. doi: 10.1002/hep.28031.
6. Karagiannakis DS, Voulgaris T, Siakavellas SI, Papatheodoridis GV, Vlachogiannakos J. Evaluation of portal hypertension in the cirrhotic patient: hepatic vein pressure gradient and beyond. Scand. J. Gastroenterol. 2018;53(10-11):1153-1164. doi: 10.1080/00365521.2018.1506046.
7. Lemoine M, Katsahian S, Ziol M, Nahon P, Ganne-Carrie N, Kazemi F, Grando-Lemaire V, Trinchet JC, Beaugrand M. Liver stiffness measurement as a predictive tool of clinically significant portal hypertension in patients with compensated hepatitis C virus or alcohol-related cirrhosis. Aliment. Pharmacol. Ther. 2008;28(9):1102-1110. doi: 10.1111/j.1365-2036.2008.03825.x.
8. Elkrief L, Rautou PE, Ronot M, Lambert S, Dioguardi Burgio M, Francoz C, Plessier A, Durand F, Valla D, Lebrec D, Vilgrain V, Castéra L. Prospective comparison of spleen and liver stiffness by using shear-wave and transient elastography for detection of portal hypertension in cirrhosis. Radiology. 2015;275(2):589-598. doi: 10.1148/radiol.14141210.
9. Kim TY, Jeong WK, Sohn JH, Kim J, Kim MY, Kim Y. Evaluation of portal hypertension by real-time shear wave elastography in cirrhotic patients. Liver Int. 2015;35(11):2416-2424. doi: 10.1111/liv.12846.
10. Salzl P, Reiberger T, Ferlitsch M, Payer BA, Schwengerer B, Trauner M, Peck-Radosavljevic M, Ferlitsch A. Evaluation of portal hypertension and varices by acoustic radiation force impulse imaging of the liver compared to transient elastography and AST to platelet ratio index. Ultraschall Med. 2014;35(6):528-533. doi: 10.1055/s-0034-1366506.
11. Berzigotti A, Seijo S, Arena U, Abraldes JG, Vizzutti F, García-Pagán JC, Pinzani M, Bosch J. Elastography, spleen size, and platelet count identify portal hypertension in patients with compensated cirrhosis. Gastroenterology. 2013;144(1):102-111.e1. doi: 10.1053/j.gastro.2012.10.001.
12. Han J-Y, Cho JH, Kwon HJ, Nam KJ. Predicting portal hypertension as assessed by acoustic radiation force impulse: correlations with the Doppler ultrasound. Br. J. Radiol. 2012;85(1016):e404-409. doi: 10.1259/bjr/74648924.
13. Bota S, Sporea I, Sirli R, Focsa M, Popescu A, Danila M, Strain M. Can ARFI elastography predict the presence of significant esophageal varices in newly diagnosed cirrhotic patients? Ann. Hepatol. 2012;11(4):519-525.
14. Morishita N, Hiramatsu N, Oze T, Harada N, Yamada R, Miyazaki M, Yakushijin T, Miyagi T, Yoshida Y, Tatsumi T, Kanto T, Takehara T. Liver stiffness measurement by acoustic radiation force impulse is useful in predicting the presence of esophageal varices or high-risk esophageal varices among patients with HCV-related cirrhosis. J. Gastroenterol. 2014;49(7):1175-1182. doi: 10.1007/s00535-013-0877-z.
15. The French METAVIR Cooperative Study Group. Intraobserver and interobserver variations in liver biopsy interpretation in patients with chronic hepatitis C. Hepatology. 1994;20(1):15-20.
16. European Association for the Study of the Liver. EASL Recommendations on Treatment of Hepatitis C 2018. J. Hepatol. 2018;69(2):461-511. doi: 10.1016/j. jhep.2018.03.026.
17. Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR. A simulation study of the number of events per variable in logistic regression analysis. J. Clin. Epidemiol. 1996;49(12):1373-1379.
18. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159-174.
19. The R Project for Statistical Computing [Internet]. Available from: http://www.R-project.org/.
