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Noninvasive tests predict portal hypertension, varices in cirrhosis

Recent findings suggest noninvasive tests can be used to identify patients with compensated liver disease at high risk for clinically significant portal hypertension and varices needing treatment.

“We provide a new way of approaching the use of [noninvasive tools] to predict key features of the natural history of patients with compensated cirrhosis; namely, we show that the numerical information derived from [noninvasive tools] can provide continuous, yet simple, risk measurement tolls in the form of nomograms,” Juan G. Abraldes, MD, division of gastroenterology, University of Alberta, Canada, and colleagues wrote.

Abraldes and colleagues conducted a cross-sectional study — known as the ANTICIPATE study — where they evaluated 518 patients with compensated cirrhosis from five centers throughout Europe and Canada, who had available data from paired noninvasive tests. These tests included: liver stiffness measurement (LSM) by transient elastography (TE), platelet count, and spleen diameter with calculation of liver stiffness to spleen/platelet score (LSPS) score and platelet-spleen ratio and endoscopy/hepatic venous pressure gradient measurement.

The goal of the research was to develop risk prediction models based on noninvasive tests, to provide a point-of-care risk assessment of this patient population, per the research.

“A significant barrier for the translation of [noninvasive tools] into practice is the use of diagnostic performance measurements without direct clinical translation. … Risk prediction modeling based on these [tools] could be a more straightforward answer to the relevant clinical question, that is, what would be the risk of [clinically significant portal hypertension], varices and [varices needing treatment] given a certain value of these noninvasive tests,” they wrote.

Results from logistic regression analyses showed noninvasive tests were reliable in the identification of patients with high risk for clinically significant portal hypertension.

LSPS values above 2.65 were associated with risks for CSPH more than 80%; the LSPS had the highest discrimination of all the tests.

The LSPS and a model combining TE and platelet count identified patients with less than 5% risk for varices needing treatment. The researchers said this suggests they may be used to triage patients requiring screening endoscopy.  

LSPS values of less than 1.33 were associated with less than 5% risk for varices needing treatment, and, per the research, 26% of patients had values below this threshold. LSM combined with platelet count predicted a risk for less than 5% of varices needing treatment in 30% of the patients. – by Melinda Stevens

Disclosures: Abraldes reports no relevant financial disclosures. One researcher reports consulting for Conatus, Exallenz and Gilead Sciences; and receiving grants from Conatus and Exallenz.