Noninvasive Diagnostics for Portal Hypertension: A Comprehensive Review

Abstract

Noninvasive diagnostics for portal hypertension include imaging and functional tests, as well as blood-based biomarkers, and capture different features of the portal hypertensive syndrome. Definitive conclusions regarding their clinical utility require assessment of their diagnostic value in specific clinical settings (i.e., diagnosing a particular hemodynamic condition within a well-defined target population). Several noninvasive methods are predictive of clinically significant portal hypertension (CSPH; hepatic venous pressure gradient [HVPG] ≥ 10 mm Hg; the threshold for complications of portal hypertension); however, only a minority of them have been evaluated in compensated advanced chronic liver disease (i.e., the target population). Importantly, most methods correlate only weakly with HVPG at high values (i.e., in patients with CSPH). Nevertheless, selected methods show promise for diagnosing HVPG ≥ 16 mm Hg (the cut-off for increased risks of hepatic decompensation and mortality) and monitoring HVPG changes in response to nonselective beta-blockers or etiological treatments. Finally, we review established and potential future clinical applications of noninvasive methods.

The impact of ABO blood type on the prevalence of portal vein thrombosis in patients with advanced chronic liver disease

“…However, in patients with clinically significant portal hypertension (CSPH), VWF levels are highly elevated, most likely as a result of portal hypertension 19 and bacterial translocation‐induced inflammation 12 . Accordingly, it is unclear if, and to what extent, ABO blood type impacts on VWF/factor VIII levels in patients with cirrhosis.…”

Thromboelastometry in patients with advanced chronic liver disease stratified by severity of portal hypertension

“…Interestingly, cACLD patients in substage 2 showed a significantly prolonged clotting time in INTEM. There are various potential reasons for this observation: First, this could be an effect of endogenous Previous studies indicate that blood tests of synthetic function are linked to the severity of portal hypertension and models including INR have been shown to indicate the presence of CSPH in cACLD patients [25]. However, all of these "easily-available" markers are in many ways inaccurate and the diagnostic and discriminatory value for CSPH (vs. no CSPH) is only moderate.…”

Perceptions on the management of varices and on the use of albumin in patients with cirrhosis among GI specialists in Austria

“…This overtreatment by short endoscopic screening intervals causes unnecessary costs and risks for the patients. Importantly, transient elastography may be used as a valuable noninvasive prescreening tool for esophageal varices when combined with a concomitant determination of the platelet count [48,49]; however, gastroscopy is still considered important in patients with PH, especially in patients who never had gastroscopy before [2], since additional findings such as portal hypertensive gastropathy may be detected as a relevant cause of upper gastrointestinal bleeding and anemia [50][51][52]. Furthermore, longer screening intervals could be considered in patients with cured hepatitis C, as sustained viral response results in a profound decrease of portal pressure [53,54].…”