Indocyanine green retention test as a noninvasive marker of portal hypertension and esophageal varices in compensated liver cirrhosis

Abstract

Noninvasive markers would be 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 the indocyanine green (ICG) retention test as a noninvasive marker of PH and EV, measured against the gold standards (hepatic venous pressure gradient [HVPG] measurement and upper endoscopy). We prospectively enrolled patients with compensated cirrhosis referral to our unit. All patients underwent laboratory tests, abdominal ultrasound, upper gastrointestinal endoscopy, HVPG measurement, and the ICG 15-minute retention (ICG-r15) test. We evaluated the sensitivity and specificity of the ICG retention test and other noninvasive tools for the diagnosis of PH and EV. Ninety-six consecutive Child-Pugh A patients (67 male and 29 female; 60.3 6 11.8 years of age) were enrolled. Seventy-four 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, whereas ICG-r15 and INR were related to EV. ICG-r15 values (<6.7% and <6.9%, respectively) were able to rule out the presence of CSPH and SPH (LR 2 0.15 and 0.14); ICG-r15 <10% provided a 97.8% sensitivity (LR 2 0.042) for the exclusion of EV and a 100% sensitivity (LR 2 0.0) for large EV. Conclusion: The ICG-r15 test is an effective tool for assessment of PH in patients with compensated cirrhosis. Although this would not replace endoscopy, the ICG-r15 appears able to identify patients with advanced liver disease in which endoscopy is mandatory as well as rule out the presence of EV in patients with compensated cirrhosis. (HEPATOLOGY 2014;59:643-650) H istological and hemodynamic alterations occurring in the course of chronic liver disease (CLD) are characterized by progressive deposition of extracellular matrix (ECM), leading to liver tissue fibrogenesis and intra-and extrahepatic vascular changes. Capillarization of hepatic sinusoids as well as development of intrahepatic shunts and neoangiogenesis lead to increased intrahepatic resistance to blood flow.1,2 Both architectural and dynamic alterations (activation of myofibroblasts and hepatic stellate cells), together with increased portal blood flow resulting from splanchnic vasodilatation, lead to the development of portal hypertension (PH).The presence of PH is commonly observed in patients with liver cirrhosis. Development of PH significantly increases the risk of complications, such as

A Comparative Study of Albumin-Bilirubin Score with Child-Pugh Score, Model for End-Stage Liver Disease Score and Indocyanine Green R15 in Predicting Posthepatectomy Liver Failure for Hepatocellular Carcinoma Patients

“…ICG R15 was the most frequently applied method for hepatic surgeons to select HCC patients for resection [27, 28], especially in Eastern countries. We were interested to know in whether the ALBI scoring system had a comparable or improved predictive value for PHLF over ICG R15.…”

Indocyanine green kinetics to assess liver function: Ready for a clinical dynamic assessment in major liver surgery?

“…Last but not least, ICG clearance parameters might be altered in case of repeated administrations if intervals between the sequential IGC injections are too short (less than 30 min): Residual ICG may change the baseline drift [6] . In contemporary clinical liver medicine, a temptative list of indications of ICG kinetic parameters could be the following [2,[6][7][8] : (1) Functional definition of the hepatic reserve in cirrhotic and non cirrhotic patients undergoing resective surgery; (2) Morbidity/mortality prediction in the same setting; (3) Functional assessment in cadaveric donors of liver function, particularly in case of extended criteria donors, and in case of living donation (beyond the scope of the review); (4) Non invasive assessment of portal hypertension (PH) and esophageal varices [25] ; and (5) Early functional assessment of the newly grafted liver.…”

“…In cirrhotic patients admitted to resective surgery, preexisting PH and postoperative parenchymal dysfunction are among the most common causes of PHLF. Recently, Lisotti et al [25] in a cohort of CHILD. A cirrhotic patients with wellpreserved liver function evaluated the accuracy of ICGR15 in reflecting the alteration of hepatic blood flow and, indirectly, the presence and grade of PH and esophageal varices (EV).…”

“…As comparators, the AAs used hepatic vein pressure gradient and upper gastrointestinal endoscopy, actually the gold standards in this setting. Interestingly enough, Lisotti et al [25] documented a good performance of ICGR15 for the diagnosis of both PH and EV. In patients with compensated cirrhosis, ICGR15 < 6.7% and < 6.9% ruled out clinically significant PH and severe PH respectively, while ICGR15 < 10% was able to exclude the presence of EV.…”

Novel circulating- and imaging-based biomarkers to enhance the mechanistic understanding of human drug-induced liver injury

“…This novel optical imaging modality has been demonstrated to have improved resolution and optical imaging accuracy combined with excellent spatial resolution and deep tissue penetration depth [89,90]. Recent applications have revealed its utility for in vivo imaging in cancer, cardiovascular disease, neurology [91], nephrotoxicity applications [92], as well as in the clinic for the non-invasive imaging of disease activity in Crohn's disease [93] and the detection of oesophageal varices [94]. MSOT imaging has also been previously used to measure kidney function in adriamycin-induced nephropathy mice model by measuring IRDye 800CW clearance through kidneys in combination with standard biochemical and histological indicators of kidney damage [92].…”