Detection of early portal hypertension with routine data and liver stiffness in patients with asymptomatic liver disease: A prospective study

Background & Aims: Detecting portal hypertension (PH) before the development of varices is important for prognosis and for designing interventional studies. None of the available strategies is used in practice. We evaluated a sequential screening-diagnostic strategy based on clinical data and transient elastography (TE) to detect PH in asymptomatic outpatients with liver disease. Methods: Consecutive patients with chronic liver disease and no previous diagnosis of PH were screened by TE. Patients with liver stiffness (LS) >= 13.6 kPa were further evaluated by endoscopy and hepatic venous pressure gradient (HVPG). For analysis, patients were classified in 3 groups: group A, platelets >= 150,000/mm(3), normal abdominal ultrasound; group B, platelets <150,000/mm(3), normal ultrasound; group C, platelets <150,000/mm(3), abnormal ultrasound (splenomegaly, nodular liver surface). Results: 250 patients were evaluated (69% group A, 20% group B, 11% group C). In 9% elastography was non-valid. LS >= 13.6 was found in 54 patients (8% A, 43% B, and 81% C, p<0.001). Endoscopy was performed in 49 of these: 20% had small varices, 0% high-risk varices. No patients from group A had varices, and 90% with varices belonged to group C. HVPG was obtained in 40 patients: 93% had PH (HVPG >5 mmHg) and 65% clinically significant PH (CSPH, HVPG >= 10). Only 3 patients, all from group A, had HVPG <5. All patients from groups B and C with LS >= 13.6 had PH. The LS 25 cut-off was excellent at ruling-in CSPH. Conclusions: A simple strategy based on routine clinical data and TE could be useful to detect early PH among asymptomatic patients with chronic liver disease. (C) 2013 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.