Elastography, spleen size, and platelet count identify portal hypertension in patients with compensated cirrhosis
BACKGROUND & AIMS: Noninvasive methods are needed to identify clinically significant portal hypertension (CSPH) and esophageal varices (EVs) in patients with compensated cirrhosis. We looked for markers of the presence of CSPH and EVs in patients with cirrhosis. METHODS: We performed a cross-section...
| Autores: | ; ; ; ; ; ; ; |
|---|---|
| Tipo de documento: | Artículo |
| Estado: | Accepted version |
| Fecha de publicación: | 2012 |
| País: | España |
| Institución: | Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya) |
| Repositorio: | Recercat. Dipósit de la Recerca de Catalunya |
| OAI Identifier: | oai:recercat.cat:2445/57783 |
| Acceso en línea: | https://hdl.handle.net/2445/57783 |
| Nivel de acceso: | Acceso abierto |
| Palabra clave: | Hipertensió portal Varices esofàgiques Cirrosi hepàtica Malalties del fetge Portal hypertension Esophageal varices Hepatic cirrhosis Liver diseases |
| _version_ | 1878739790244872192 |
|---|---|
| author | Berzigotti, Annalisa |
| author2 | Seijo Ríos, Susana Arena, Umberto Abraldes, Juan G. Vizzutti, Francesco García Pagán, Juan Carlos Pinzani, Massimo Bosch i Genover, Jaume |
| author2_role | author author author author author author author |
| author_browse | Abraldes, Juan G. Arena, Umberto Berzigotti, Annalisa Bosch i Genover, Jaume García Pagán, Juan Carlos Pinzani, Massimo Seijo Ríos, Susana Vizzutti, Francesco |
| author_facet | Berzigotti, Annalisa Seijo Ríos, Susana Arena, Umberto Abraldes, Juan G. Vizzutti, Francesco García Pagán, Juan Carlos Pinzani, Massimo Bosch i Genover, Jaume |
| author_role | author |
| collection | Recercat. Dipósit de la Recerca de Catalunya |
| description | BACKGROUND & AIMS: Noninvasive methods are needed to identify clinically significant portal hypertension (CSPH) and esophageal varices (EVs) in patients with compensated cirrhosis. We looked for markers of the presence of CSPH and EVs in patients with cirrhosis. METHODS: We performed a cross-sectional study that included a training set of 117 patients with compensated cirrhosis, confirmed by histology, from a tertiary referral center. Spleen diameter was measured by ultrasound, and liver stiffness (LS) was measured by transient elastography; endoscopy was used as the standard for detection of EVs, and measurements of hepatic venous pressure gradient were used as the standard for identifying CSPH. We assessed the ability of platelet count, spleen diameter, LS, and combinations of these factors (ie, ratio of platelet count to spleen size, and LS × spleen size/platelet count [LSPS]) to identify patients with CSPH and EV. The analysis included 2 new statistical models: the PH risk score and the varices risk score. Results were validated using an independent series of 56 patients with compensated patients from another center. RESULTS: LS was the best single noninvasive variable for identifying patients with CSPH (area under the receiver operating characteristic, 0.883; 95% confidence interval [CI], 0.824-0.943; P < .0001). The area under the receiver operating characteristic value increased when LS was combined with platelet count and spleen size, either as LSPS (0.918; 95% CI, 0.872-0.965; P < .0001) or PH risk score (0.935; 95% CI, 0.893-0.977; P < .0001). More than 80% of patients were accurately classified using LSPS and PH risk score. Analyses of the varices risk score and LSPS were superior to all other noninvasive tests for identifying patients with EVs (area under the receiver operating characteristic, 0.909; 95% CI, 0.841-0.954 and 0.882; 95% CI, 0.810-0.935, respectively); they correctly classified 85% of patients in the training set and 75% in the validation set. CONCLUSIONS: Combined data on LS, spleen diameter, and platelet count can be used to identify patients with compensated cirrhosis most likely to have CSPH and EV. |
| eu_rights_str_mv | openAccess |
| format | article |
| id | ES_c80fe26ed3550a91d23ab8a4d93c6d0b |
| institution | Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya) |
| instname_str | Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya) |
| network_acronym_str | ES |
| network_name_str | España |
| oai_identifier_str | oai:recercat.cat:2445/57783 |
| publishDate | 2012 |
| publishDateSort | 2012 |
| publisher | Elsevier B.V. |
| publisherStr | Elsevier B.V. |
| reponame_str | Recercat. Dipósit de la Recerca de Catalunya |
| spelling | Elastography, spleen size, and platelet count identify portal hypertension in patients with compensated cirrhosis Berzigotti, Annalisa Seijo Ríos, Susana Arena, Umberto Abraldes, Juan G. Vizzutti, Francesco García Pagán, Juan Carlos Pinzani, Massimo Bosch i Genover, Jaume Hipertensió portal Varices esofàgiques Cirrosi hepàtica Malalties del fetge Portal hypertension Esophageal varices Hepatic cirrhosis Liver diseases BACKGROUND & AIMS: Noninvasive methods are needed to identify clinically significant portal hypertension (CSPH) and esophageal varices (EVs) in patients with compensated cirrhosis. We looked for markers of the presence of CSPH and EVs in patients with cirrhosis. METHODS: We performed a cross-sectional study that included a training set of 117 patients with compensated cirrhosis, confirmed by histology, from a tertiary referral center. Spleen diameter was measured by ultrasound, and liver stiffness (LS) was measured by transient elastography; endoscopy was used as the standard for detection of EVs, and measurements of hepatic venous pressure gradient were used as the standard for identifying CSPH. We assessed the ability of platelet count, spleen diameter, LS, and combinations of these factors (ie, ratio of platelet count to spleen size, and LS × spleen size/platelet count [LSPS]) to identify patients with CSPH and EV. The analysis included 2 new statistical models: the PH risk score and the varices risk score. Results were validated using an independent series of 56 patients with compensated patients from another center. RESULTS: LS was the best single noninvasive variable for identifying patients with CSPH (area under the receiver operating characteristic, 0.883; 95% confidence interval [CI], 0.824-0.943; P < .0001). The area under the receiver operating characteristic value increased when LS was combined with platelet count and spleen size, either as LSPS (0.918; 95% CI, 0.872-0.965; P < .0001) or PH risk score (0.935; 95% CI, 0.893-0.977; P < .0001). More than 80% of patients were accurately classified using LSPS and PH risk score. Analyses of the varices risk score and LSPS were superior to all other noninvasive tests for identifying patients with EVs (area under the receiver operating characteristic, 0.909; 95% CI, 0.841-0.954 and 0.882; 95% CI, 0.810-0.935, respectively); they correctly classified 85% of patients in the training set and 75% in the validation set. CONCLUSIONS: Combined data on LS, spleen diameter, and platelet count can be used to identify patients with compensated cirrhosis most likely to have CSPH and EV. Elsevier B.V. https://hdl.handle.net/2445/57783 |
| spellingShingle | Elastography, spleen size, and platelet count identify portal hypertension in patients with compensated cirrhosis Berzigotti, Annalisa Hipertensió portal Varices esofàgiques Cirrosi hepàtica Malalties del fetge Portal hypertension Esophageal varices Hepatic cirrhosis Liver diseases |
| status_str | acceptedVersion |
| title | Elastography, spleen size, and platelet count identify portal hypertension in patients with compensated cirrhosis |
| title_full | Elastography, spleen size, and platelet count identify portal hypertension in patients with compensated cirrhosis |
| title_fullStr | Elastography, spleen size, and platelet count identify portal hypertension in patients with compensated cirrhosis |
| title_full_unstemmed | Elastography, spleen size, and platelet count identify portal hypertension in patients with compensated cirrhosis |
| title_short | Elastography, spleen size, and platelet count identify portal hypertension in patients with compensated cirrhosis |
| title_sort | Elastography, spleen size, and platelet count identify portal hypertension in patients with compensated cirrhosis |
| topic | Hipertensió portal Varices esofàgiques Cirrosi hepàtica Malalties del fetge Portal hypertension Esophageal varices Hepatic cirrhosis Liver diseases |
| topic_facet | Hipertensió portal Varices esofàgiques Cirrosi hepàtica Malalties del fetge Portal hypertension Esophageal varices Hepatic cirrhosis Liver diseases |
| url | https://hdl.handle.net/2445/57783 |