Estamos realizando la búsqueda. Por favor, espere...
1583
37
170
29013
4402
2599
347
386
Abstract: Background & aims: Non-invasive tests (NITs) for clinically significant portal hypertension (CSPH; hepatic venous pressure gradient [HVPG] ?10 mmHg) have predominantly been studied in patients with active HCV infection. Investigations after HCV cure are limited and have yielded conflicting results. We conducted a pooled analysis to determine the diagnostic/prognostic utility of liver stiffness measurement (LSM)/platelet count (PLT) in this setting. Methods: A total of 418 patients with pre-treatment HVPG ?6 mmHg who achieved sustained virological response (SVR) and underwent post-treatment HVPG measurement were assessed, of whom 324 (HVPG/NIT-cohort) also had paired data on pre-/post-treatment LSM/PLT. The derived LSM/PLT criteria were then validated against the direct endpoint decompensation in 755 patients with compensated advanced chronic liver disease (cACLD) with SVR (cACLD-validation-cohort). Results: HVPG/NIT-cohort: Among patients with cACLD, the pre-/post-treatment prevalence of CSPH was 80%/54%. The correlation between LSM/HVPG increased from pre- to post-treatment (r = 0.45 vs. 0.60), while that of PLT/HVPG remained unchanged. For given LSM/PLT values, HVPG tended to be lower post- vs. pre-treatment, indicating the need for dedicated algorithms. Combining post-treatment LSM/PLT yielded a high diagnostic accuracy for post-treatment CSPH in cACLD (AUC 0.884; 95% CI 0.843-0.926). Post-treatment LSM <12 kPa & PLT >150 G/L excluded CSPH (sensitivity: 99.2%), while LSM ?25 kPa was highly specific for CSPH (93.6%). cACLD-validation-cohort: the 3-year decompensation risk was 0% in the 42.5% of patients who met the LSM <12 kPa & PLT >150 G/L criteria. In patients with post-treatment LSM ?25 kPa (prevalence: 16.8%), the 3-year decompensation risk was 9.6%, while it was 1.3% in those meeting none of the above criteria (prevalence: 40.7%). Conclusions: NITs can estimate the probability of CSPH after HCV cure and predict clinical outcomes. Patients with cACLD but LSM <12 kPa & PLT>150 G/L may be discharged from portal hypertension surveillance if no co-factors are present, while patients with LSM ?25 kPa require surveillance/treatment.
Fuente: Journal of hepatology 2022 Dec;77(6):1573-1585
Editorial: Elsevier
Año de publicación: 2022
Nº de páginas: 14
Tipo de publicación: Artículo de Revista
DOI: 10.1016/j.jhep.2022.08.025
ISSN: 0168-8278,1600-0641
Url de la publicación: https://doi.org/10.1016/j.jhep.2022.08.025
Leer publicación
SEMMLER, GEORG
LENS, SABELA
MEYER, ELIAS L.
BAIGES, ANNA
ALVARADO-TAPIAS, EDILMAR
LLOP, ELBA
TELLEZ, LUIS
SCHWABL, PHILIPP
MAURO, EZEQUIEL
ESCUDÉ, LAIA
DÍEZ, CRISTINA
IBÁÑEZ-SAMANIEGO, LUIS
ANGELA MARIA PUENTE SANCHEZ
JOSE IGNACIO FORTEA ORMAECHEA
ABADÍA, MARTA
ZANETTO, ALBERTO
CONTHE, ANDRÉS
HERNÁNDEZ-ÉVOLE, HELENA
LUZKO SHEID, IRINA SOFIA
JIA, JIDONG
Volver