Blood‐ and Liver Stiffness‐Based Non‐Invasive Tests for Clinically Significant Portal Hypertension in Patients With
cACLD
and
HCC
Lorenz Balcar, Tina Jasmin Haunold, Mathias Jachs, Georg Semmler, Benedikt Simbrunner, Albert Friedrich Stättermayer, David Pereyra, Christoph Schwarz, Stefan Stremitzer, Klaus Kaczirek, Patrick Starlinger, Peter Quehenberger, Michael Trauner, Bernhard Scheiner, Thomas Reiberger, Matthias Pinter, Mattias Mandorfer ABSTRACT
Background and Aims
The applicability of non‐invasive tests (NITs) for clinically significant portal hypertension (CSPH) in patients with hepatocellular carcinoma (HCC) is controversial. We performed a head‐to‐head comparison of various NITs for CSPH and evaluated rule‐in/‐out criteria.
Methods
We conducted a retrospective study including 283 patients with HCC undergoing hepatic venous pressure gradient (HVPG) measurement at the Vienna Hepatic Haemodynamic Lab with available, same‐day data on NITs (i.e., liver stiffness measurement [LSM], platelet count [PLT], von Willebrand factor antigen [VWF:Ag], and the ratio of VWF:Ag and PLT [VITRO]). For the subsequent analysis, we focused on patients with compensated advanced chronic liver disease (cACLD).
Results
Among 164 patients with cACLD, most were BCLC 0/A (50.6%) and CSPH prevalence was 46.3%, the median LSM was 20.0 kPa (IQR: 13.3–37.9), and mean VWF:Ag/VITRO was 266 ± 119%/2.30 ± 1.81. The VITRO score yielded the highest discriminative ability to detect CSPH (AUROC: 0.834), followed by ANTICIPATE ± NASH (AUROC: 0.822), PLT (AUROC: 0.803), LSM (AUROC: 0.779), and VWF:Ag (AUROC: 0.707). The application of the Baveno VII criterium (LSM ≤ 15 kPa & PLT ≥ 150G/L) and the VITRO score (≤ 1.0) individually showed an excellent performance for ruling‐out CSPH (sensitivities: ≥ 95%, NPV: 100%/87.9%). For ruling‐in CSPH by individual criteria, the VITRO score provided the highest PPV (≥ 2.5, specificity/PPV: 89.8%/83.0%), followed by the Baveno VII criteria (specificity/PPV: 81.8%/74.6%). When sequentially applying Baveno VII criteria and VITRO, the grey zone could be significantly reduced to 16% (sensitivity/NPV: 94.7%/92.2%; specificity/PPV: 73.9%/84.4%).
Conclusion
The discriminative ability in patients with cACLD and HCC was comparable to patients without HCC. However, PPVs of established criteria were < 90%, which may be explained by the comparatively low prevalence of CSPH in this context.