Erschienen in:
04.05.2017
Hepatic venous pressure gradient correlates with advanced hepatic fibrosis: a retrospective review
verfasst von:
Jonathan K. Vincent, Christopher Stark, Joseph T. Shields, Anant D. Bhave, Christopher S. Morris
Erschienen in:
Abdominal Radiology
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Ausgabe 11/2017
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Abstract
Purpose
To determine if hepatic venous pressure gradient (HVPG) correlates with advanced hepatic fibrosis, as a complement to transjugular (transvenous) core needle liver biopsy.
Materials and methods
After institutional review board approval, a retrospective review was conducted on 340 patients who underwent transjugular (transvenous) core needle liver biopsy with concurrent pressure measurements between 6/1/2007 and 6/1/2013. Spearman correlation and linear regression were performed. A receiver operating characteristic (ROC) curve was created and sensitivity, specificity, predictive values and likelihood ratios were calculated.
Results
Indications included hepatitis C, abnormal liver function tests, non-alcoholic steatohepatitis, autoimmune hepatitis, and cirrhosis, among others. Biopsies showed stage 1 or 2 fibrosis in 15.6% each, stage 3 fibrosis in 21.6%, stage 4 fibrosis in 40.7%, and no fibrosis in 6.5%. Mean HVPG was 6.5 mm Hg (SD 5.0) with a range of 0–26 mm Hg. Spearman correlation coefficient for association between HVPG and fibrosis stage was 0.561 (p < 0.001). R2 on linear regression was 0.247 (p < 0.001). ROC curve for the prediction of stage 4 fibrosis had an area under the curve of 0.79 (95% CI 0.73–0.85). HVPG of ≥6 mm Hg had a sensitivity of 71.3%, specificity of 79.6%, positive predictive value of 70.5%, negative predictive value of 80.2%, positive likelihood ratio of 3.49 (95% CI 2.45–4.97) and negative likelihood ratio of 0.36 (95% CI 0.26–0.50) for diagnosis of stage 4 fibrosis.
Conclusions
HVPG correlates with stage 4 (advanced) hepatic fibrosis.