Introduction: Measurement of hepatic venous pressure gradient (HVPG) is the gold standard for the assessment of portal hypertension (PH) and the prediction of clinical decompensation in patients with cirrhosis and PH. The development of non-invasive methodologies able to identify clinically significant PH and predict disease progression is needed. Indocyanine green clearance at 15 minutes (IcgR15) is an index of liver blood flow, functioning hepatocyte mass and energy status of the liver. In this ongoing study, we evaluate the ability of IcgR15 and other non-invasive tests to predict PH in patients with chronic liver disease of various etiology. Methods: Sixty-seven consecutive patients (43M/34F, mean age 61.09±12.57; age range 33 - 84 years) with chronic liver disease underwent HVPG measurement in our radiological unit between January and November 2010. All patients underwent laboratory tests, EGDS, abdominal ultrasound and IcgR15. Mann-Whitney test and multiple regression analysis has been performed in order to identify variables independently associated with HVPG>10mmHg, HVPG>12 and gastro-esophageal varices (GEV). ROC curves were used to define the best cut-off (Medcalc software v11.4). Results: Platelets count (P<0.0001) and IcgR15 (respectively P=0.0001 and P<0.0001) were independently related with HVPG>10 and HVPG>12 while bilirubin, albumin, INR, MELD, spleen diameter, APRI were not. On multiple regression both platelets count and IcgR15 were significantly related to HVPG>10 (respectively P=0.0004 and 0.02, r= -0.54 and r= 0.45) and HVPG>12 (respectively P=0.007 and P<0.0001, r= -0.50 and r= 0.60). Moreover IcgR15 is related to the presence of GEV (P<0.0001). ROC curves identified PLT≤130.000 (sensitivity 74.5%, specificity 80.0%, AUROC 0.82, P<0.0001) and IcgR15>9.7% (sensitivity 83.0%, specificity 65.0%, AUROC 0.81, P<0.0001) as the best cut off to predict HVPG>10mmHg and PLT≤123.000 (sensitivity 76.3%, specificity 75.9%, AUROC 0.81, P<0.0001) and IcgR15>12.4% (sensitivity 84.2%, specificity 72.4%, AUROC 0.87, P<0.0001) for HVPG>12mmHg. ROC curve identified IcgR15>10.5% as the best predictor of GEV presence (sensitivity 87.2%, specificity 67.9%, AUROC 0.80, P<0.0001). Discussion: IcgR15 together with total platelets count are good non-invasive predictors of PH. Moreover, IcgR15 seems to be a valid predictor of GEV presence in cirrhotic patients.
Lisotti A, A.F. (2011). Indocyanine green as a predictor of clinically significant portal hypertension in a prospective cohort study of patients with chronic liver disease. DIGESTIVE AND LIVER DISEASE, 43(Suppl.2), 96-96.
Indocyanine green as a predictor of clinically significant portal hypertension in a prospective cohort study of patients with chronic liver disease.
Lisotti A;Azzaroli F;Buonfiglioli F;Cecinato P;Calvanese C;Lodato F;Montagnani M;Golfieri R;Festi D;Mazzella G
2011
Abstract
Introduction: Measurement of hepatic venous pressure gradient (HVPG) is the gold standard for the assessment of portal hypertension (PH) and the prediction of clinical decompensation in patients with cirrhosis and PH. The development of non-invasive methodologies able to identify clinically significant PH and predict disease progression is needed. Indocyanine green clearance at 15 minutes (IcgR15) is an index of liver blood flow, functioning hepatocyte mass and energy status of the liver. In this ongoing study, we evaluate the ability of IcgR15 and other non-invasive tests to predict PH in patients with chronic liver disease of various etiology. Methods: Sixty-seven consecutive patients (43M/34F, mean age 61.09±12.57; age range 33 - 84 years) with chronic liver disease underwent HVPG measurement in our radiological unit between January and November 2010. All patients underwent laboratory tests, EGDS, abdominal ultrasound and IcgR15. Mann-Whitney test and multiple regression analysis has been performed in order to identify variables independently associated with HVPG>10mmHg, HVPG>12 and gastro-esophageal varices (GEV). ROC curves were used to define the best cut-off (Medcalc software v11.4). Results: Platelets count (P<0.0001) and IcgR15 (respectively P=0.0001 and P<0.0001) were independently related with HVPG>10 and HVPG>12 while bilirubin, albumin, INR, MELD, spleen diameter, APRI were not. On multiple regression both platelets count and IcgR15 were significantly related to HVPG>10 (respectively P=0.0004 and 0.02, r= -0.54 and r= 0.45) and HVPG>12 (respectively P=0.007 and P<0.0001, r= -0.50 and r= 0.60). Moreover IcgR15 is related to the presence of GEV (P<0.0001). ROC curves identified PLT≤130.000 (sensitivity 74.5%, specificity 80.0%, AUROC 0.82, P<0.0001) and IcgR15>9.7% (sensitivity 83.0%, specificity 65.0%, AUROC 0.81, P<0.0001) as the best cut off to predict HVPG>10mmHg and PLT≤123.000 (sensitivity 76.3%, specificity 75.9%, AUROC 0.81, P<0.0001) and IcgR15>12.4% (sensitivity 84.2%, specificity 72.4%, AUROC 0.87, P<0.0001) for HVPG>12mmHg. ROC curve identified IcgR15>10.5% as the best predictor of GEV presence (sensitivity 87.2%, specificity 67.9%, AUROC 0.80, P<0.0001). Discussion: IcgR15 together with total platelets count are good non-invasive predictors of PH. Moreover, IcgR15 seems to be a valid predictor of GEV presence in cirrhotic patients.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
