Indocyanine green retention test as a non-invasive marker of portal hypertension and esophageal varices in compensated liver cirrhosis.

Non-invasive markers are useful for the assessment of portal hypertension(PH) and esophageal varices(EV) in patients with cirrhosis. The aim of our study was to evaluate the performance of Indocyanine Green(ICG) retention test as a non-invasive marker of PH and EV, measured with the gold standards (HVPG measurement and upper endoscopy). We prospectively enrolled patients with compensated cirrhosis referral to our unit. All patients underwent laboratory tests, abdominal ultrasound, upper GI endoscopy, HVPG measurement and ICG "15-minute" retention test. We evaluated the sensibility and specificity of ICG retention test and other non-invasive tools for the diagnosis of PH and EV. 96 consecutive Child A patients (67M/29F, 60.3 ± 11.8 years) were enrolled. 74 patients had clinically significant portal hypertension(CSPH), of whom 59 had severe portal hypertension(SPH). ICG-r15 and Lok Index were independently related to the presence of both CSPH and SPH, while ICG-r15 and INR to EV. ICG-r15 values (<6.7% and <6.9%, respectively) are able to rule out the presence of CSPH and SPH (-LR 0.15 and 0.14); ICG-r15 < 10% presents a 97.8% sensitivity (-LR 0.042) for the exclusion of EV and a 100% sensitivity (-LR 0.0) for large EV. Conclusion: ICG "15-minute" retention test is an effective tool for the assessment of PH in patients with compensated cirrhosis. Although we are still far from the replacement of endoscopy, ICG-r15 seems to be able to identify patients with advanced liver disease in which endoscopy is mandatory, and to rule out the presence of EV in patients with compensated cirrhosis.