L Elkrief1,2, M Ronot3,4, F Andrade2, M Dioguardi Burgio3,4, T Issoufaly2, M Zappa3,4, O Roux2,4, J Bissonnette2, A Payancé2, D Lebrec2,4, C Francoz2,4, O Soubrane4,5, D Valla2,4, F Durand2,4, V Vilgrain3,4, L Castera2,4, P-E Rautou2,6. 1. Service d'Hépatologie et Gastroentérologie, Hôpitaux Universitaires de Genève, Suisse, Switzerland. 2. Service d'Hépatologie, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, Clichy, France. 3. Service de radiologie, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, Clichy, France. 4. UMR 1149, Inserm, Université Paris Diderot Paris 7, Centre de Recherche sur l' Inflammation (CRI), Paris. 5. Service de chirurgie digestive, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, Clichy, France. 6. UMR-970, Paris Cardiovascular Research Center - PARCC, INSERM, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
Abstract
BACKGROUND: Two algorithms based on sequential measurements of liver and spleen stiffness using two-dimensional shearwave elastography (2D-SWE) have been recently proposed to estimate clinically significant portal hypertension (hepatic venous pressure gradient [HVPG] ≥10 mm Hg) in patients with cirrhosis, with excellent diagnostic accuracy. AIM: To validate externally these algorithms in a large cohort of patients with cirrhosis. METHODS: One hundred and ninety-one patients with stable cirrhosis (Child-Pugh class A 39%, B 29% and C 31%) who underwent liver and spleen stiffness measurements using 2D-SWE at the time of HVPG measurement were included. Diagnostic accuracy of the 2 algorithms was assessed by calculating sensitivity, specificity, positive and negative predictive values. RESULTS: The first algorithm, using liver stiffness <16.0 kilopascals (kPa) and then spleen stiffness <26.6 kPa, was used to rule-out HVPG ≥10 mm Hg. In our population, its sensitivity and negative predictive value were 95% and 63% respectively. The second algorithm, using liver stiffness >38.0 kPa, or liver stiffness ≤38.0 kPa but spleen stiffness >27.9 kPa, was used to rule-in HVPG ≥10 mm Hg. In our population, its specificity and positive predictive value were 52% and 83% respectively. Restricting the analyses to the 74 patients without any history of decompensation of cirrhosis or to the 65 patients with highly reliable liver stiffness measurement did not improve the results. CONCLUSION: In our population, diagnostic accuracies of non-invasive algorithms based on sequential measurements of liver and spleen stiffness using 2D-SWE were acceptable, but not good enough to replace HVPG measurement or to base clinical decisions.
BACKGROUND: Two algorithms based on sequential measurements of liver and spleen stiffness using two-dimensional shearwave elastography (2D-SWE) have been recently proposed to estimate clinically significant portal hypertension (hepatic venous pressure gradient [HVPG] ≥10 mm Hg) in patients with cirrhosis, with excellent diagnostic accuracy. AIM: To validate externally these algorithms in a large cohort of patients with cirrhosis. METHODS: One hundred and ninety-one patients with stable cirrhosis (Child-Pugh class A 39%, B 29% and C 31%) who underwent liver and spleen stiffness measurements using 2D-SWE at the time of HVPG measurement were included. Diagnostic accuracy of the 2 algorithms was assessed by calculating sensitivity, specificity, positive and negative predictive values. RESULTS: The first algorithm, using liver stiffness <16.0 kilopascals (kPa) and then spleen stiffness <26.6 kPa, was used to rule-out HVPG ≥10 mm Hg. In our population, its sensitivity and negative predictive value were 95% and 63% respectively. The second algorithm, using liver stiffness >38.0 kPa, or liver stiffness ≤38.0 kPa but spleen stiffness >27.9 kPa, was used to rule-in HVPG ≥10 mm Hg. In our population, its specificity and positive predictive value were 52% and 83% respectively. Restricting the analyses to the 74 patients without any history of decompensation of cirrhosis or to the 65 patients with highly reliable liver stiffness measurement did not improve the results. CONCLUSION: In our population, diagnostic accuracies of non-invasive algorithms based on sequential measurements of liver and spleen stiffness using 2D-SWE were acceptable, but not good enough to replace HVPG measurement or to base clinical decisions.
Authors: Jérémy Dana; Aïna Venkatasamy; Antonio Saviano; Joachim Lupberger; Yujin Hoshida; Valérie Vilgrain; Pierre Nahon; Caroline Reinhold; Benoit Gallix; Thomas F Baumert Journal: Hepatol Int Date: 2022-02-09 Impact factor: 9.029
Authors: Sona Frankova; Mariia Lunova; Halima Gottfriedova; Renata Senkerikova; Magdalena Neroldova; Jozef Kovac; Eva Kieslichova; Vera Lanska; Petr Urbanek; Julius Spicak; Milan Jirsa; Jan Sperl Journal: PLoS One Date: 2021-01-07 Impact factor: 3.240