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ELF, sCD163 scores accurately predict portal hypertension in cirrhosis

The Enhanced Liver Fibrosis score combined with soluble CD163 marker successfully predicted significant portal hypertension in patients with cirrhosis.

“This may be clinically useful for screening purposes and supports the concept of both an inflammatory and a fibrotic component of hepatic blood flow resistance and portal hypertension in patients with liver cirrhosis,” T.D. Sandahl, MD, of the department of hepatology and gastroenterology, Aarhus University Hospital, Denmark, and colleagues wrote.

The researchers studied soluble (s)CD163 and the Enhanced Liver Fibrosis (ELF) score components from two independent cohorts of patients with cirrhosis who underwent hepatic vein catheterisation: 80 patients from Spain were used to develop a CD163-fibrosis portal hypertension score and 80 Danish patients were used as a validation cohort.

“We hypothesized that an optimized combined score is superior to anyone of the individual measures,” the researchers wrote.

Results showed both sCD163 and the ELF components increased in a “stepwise manner” with the patient Child-Pugh score, indicating the sCD163 and individual ELF components and ELF score were correlated in all patients (P < .001 for all). Ninety percent of patients in the estimation cohort and 80% in the validation cohort had a hepatic venous pressure gradient (HVPG) greater than 10 mmHg (72 vs. 64). The HVPG increased with the Child-Pugh class (P < .001).

The receiver operator characteristics analyses showed that each one of the individual components predicted a HVPG greater than 10 mmHg — indicating significant portal hypertension — with area under the receiver operating curve (AUROC) of approximately 0.8.

The combined score optimized by logistic regression analyses improved the AUROC to 0.91 in the estimation cohort and 0.9 in the validation cohort. In addition, patients with a high value of 3.6 had higher short-term mortality (48%) vs. patients with a lower value (18%; P = .03).

“The field of noninvasive diagnosis of portal hypertension has rapidly developed in recent years, and our study using simple [enzyme-linked immunosorbent assay] methods and disease specific pathogenic biomarkers may be a step forward in identifying patients with [clinically significant portal hypertension] that will benefit from invasive procedures like endoscopic surveillance to even HVPG measurement,” the researchers wrote. – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.