Transient elastography versus hepatic venous pressure gradient for diagnosing portal hypertension: a systematic review and meta-analysis
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Background/Aims: Transient elastography (TE) has been proposed as a promising noninvasive alternative to hepatic venous pressure gradient (HVPG) for detecting portal hypertension (PH). However, previous studies have yielded conflicting results. We gathered evidence from literature on the clinical usefulness of TE versus HVPG for assessing PH. Methods: We conducted a systematic review by searching databases for relevant literature evaluating the clinical usefulness of non-invasive TE for assessing PH in patients with cirrhosis. A literature search in Ovid Medline, EMBASE and the Cochrane Library was performed for all studies published prior to December 30, 2015. Results: Eight studies (1,356 patients) met our inclusion criteria. For the detection of PH (HVPG ≥6 mmHg), the summary sensitivity and specificity were 0.88 (95% confidence interval [CI] 0.86-0.90) and 0.74 (95% CI 0.67-0.81), respectively. Regarding clinically significant PH (HVPG ≥10 mmHg), the summary sensitivity and specificity were 0.85 (95% CI 0.63-0.97) and 0.71 (95% CI 0.50-0.93), respectively. The overall correlation estimate of TE and HVPG was large (0.75, 95% CI: 0.65; 0.82, P<0.0001). Conclusions: TE showed high accuracy and correlation for detecting the severity of PH. Therefore, TE shows promise as a reliable and non-invasive procedure for the evaluation of PH that should be integrated into clinical practice.
Abstract
Background/Aims: Transient elastography (TE) has been proposed as a promising noninvasive alternative to hepatic venous pressure gradient (HVPG) for detecting portal hypertension (PH). However, previous studies have yielded conflicting results. We gathered evidence from literature on the clinical usefulness of TE versus HVPG for assessing PH. Methods: We conducted a systematic review by searching databases for relevant literature evaluating the clinical usefulness of non-invasive TE for assessing PH in patients with cirrhosis. A literature search in Ovid Medline, EMBASE and the Cochrane Library was performed for all studies published prior to December 30, 2015. Results: Eight studies (1,356 patients) met our inclusion criteria. For the detection of PH (HVPG ≥6 mmHg), the summary sensitivity and specificity were 0.88 (95% confidence interval [CI] 0.86-0.90) and 0.74 (95% CI 0.67-0.81), respectively. Regarding clinically significant PH (HVPG ≥10 mmHg), the summary sensitivity and specificity were 0.85 (95% CI 0.63-0.97) and 0.71 (95% CI 0.50-0.93), respectively. The overall correlation estimate of TE and HVPG was large (0.75, 95% CI: 0.65; 0.82, P<0.0001). Conclusions: TE showed high accuracy and correlation for detecting the severity of PH. Therefore, TE shows promise as a reliable and non-invasive procedure for the evaluation of PH that should be integrated into clinical practice.
참고문헌 (22)
- Kim MY, "Histological subclassification of cirrhosis using the Laennec fibrosis scoring system correlates with clinical stage and grade of portal hypertension", J Hepatol, 55, pp.1004~1009 (2011)
- 장윤옥, "Inhibition of hepatic stellate cells by bone marrow-derived mesenchymal stem cells in hepatic fibrosis", Clinical and Molecular Hepatology, 21(2), pp.141~149 (2015), 대한간학회
- 엄영우, "Mesenchymal stem cell therapy for liver fibrosis", The Korean Journal of Internal Medicine, 30(5), pp.580~589 (2015), 대한내과학회[DOI]
- Eom YW, "Mesenchymal stem cell therapy for cirrhosis:present and future perspectives", World J Gastroenterol, 21, pp.10253~10261 (2015)
- Baik SK, "Haemodynamic evaluation by Doppler ultrasonography in patients with portal hypertension: a review", Liver Int, 30, pp.1403~1413 (2010)
- Kim MY, "Hepatic vein arrival time as assessed by contrast‐enhanced ultrasonography is useful for the assessment of portal hypertension in compensated cirrhosis", Hepatology, 56, pp.1053~1062 (2012)
- Kim MY, "Invasive and non-invasive diagnosis of cirrhosis and portal hypertension", World J Gastroenterol, 20, pp.4300~4315 (2014)
- Vizzutti F, "Liver stiffness measurement predicts severe portal hypertension in patients with HCV‐related cirrhosis", Hepatology, 45, pp.1290~1297 (2007)
- Lemoine M, "Liver stiffness measurement as a predictive tool of clinically significant portal hypertension in patients with compensated hepatitis C virus or alcohol‐related cirrhosis", Aliment Pharmacol Ther, 28, pp.1102~1110 (2008)
- Bureau C, "Transient elastography accurately predicts presence of significant portal hypertension in patients with chronic liver disease", Aliment Pharmacol Ther, 27, pp.1261~1268 (2008)
- Sánchez‐Conde M, "Use of transient elastography (FibroScan®) for the noninvasive assessment of portal hypertension in HIV", HCV‐coinfected patients, 2011, pp.18, 685~691
- Carrión JA, "Transient elastography for diagnosis of advanced fibrosis and portal hypertension in patients with hepatitis C recurrence after liver transplantation", Liver Transpl, 12, pp.1791~1798 (2006)
- Reiberger T, "Noninvasive screening for liver fibrosis and portal hypertension by transient elastography--a large single center experience", Wien Klin Wochenschr, 124, pp.395~402 (2012)
- Berzigotti A, "Elastography, spleen size, and platelet count identify portal hypertension in patients with compensated cirrhosis", Gastroenterology, 144, pp.102~111 (2013)
- Llop E, "Assessment of portal hypertension by transient elastography in patients with compensated cirrhosis and potentially resectable liver tumors", J Hepatol, 56, pp.103~108 (2012)
- Kim G, "Overview and recent trends of systematic reviews and meta-analyses in hepatology", Clin Mol Hepatol, 20, pp.137~150 (2014)
- 김가은, "The Accuracy of Ultrasonography for the Evaluation of Portal Hypertension in Patients with Cirrhosis: A Systematic Review", Korean Journal of Radiology, 16(2), pp.314~324 (2015), 대한영상의학회[DOI]
- 김가은, "Assessment for Risk of Bias in Systematic Reviews and Meta-Analyses in the Field of Hepatology", Gut and Liver, 9(6), pp.701~706 (2015), 거트앤리버 발행위원회
- 김가은, "Therapeutic Effects of Mesenchymal Stem Cells for Patients with Chronic Liver Diseases: Systematic Review and Meta-analysis", Journal of Korean Medical Science, 30(10), pp.1405~1415 (2015), 대한의학회
- Kim G, "The need for histological subclassification of cirrhosis: a systematic review and meta-analysis", Liver Int, 36, pp.847~855 (2016)
- Shi KQ, "Transient elastography: a meta-analysis of diagnostic accuracy in evaluation of portal hypertension in chronic liver disease", Liver Int, 33, pp.62~71 (2013)
- Higgins JPT, "Cochrane handbook for systematic reviews of interventions. Vol 4" (2011), John Wiley & Sons