Correlation of transient elastography with hepatic venous pressure gradient in patients with cirrhotic portal hypertension: A study of 326 patients from India

Table 1 Demographic profile of the study population

Parameter	Value (n = 326)
Gender
Males	263 (81)
Females	63 (19)
Age, yr	52 (16-90)
BMI, kg/m2	23 (17-41)
Etiology
NASH/cryptogenic	148 (45)
Alcohol	110 (34)
Viral (HBV/HCV)	48 (15)
Others (including mixed etiology)	20 (6)
Ascites
None	161 (49)
Mild	135 (42)
Moderate to tense	30 (9)
Bleeding status
Bleeder	118 (36)
Non-bleeder	208 (64)
Hemoglobin, g/dL	10.3 (4.5-17.0)
Platelets, × 103/cumm	90 (13-422)
Bilirubin, mg/dL	1.6 (0.2-11.2)
AST, IU/dL	53 (16-209)
INR	1.3 (0.9-3.2)
Serum albumin, g/dL	3.0 (1.2-4.6)
CTP score	7 (5-12)
MELD score	12 (6-37)
Varices present	293 (90)
Esophageal varices	280 (86)
Small varices	170/280 (61)
Large varices	110/280 (39)
Gastric varices	79 (24)
Small varices	52/79 (66)
Large varices	27/79 (34)
HVPG, mmHg	16.0 (1.5-30.5)
Transient elastography, kPa	36 (3-75)

All values are expressed as the median (range) or n (%). NASH: Non-alcoholic steatohepatitis; HBV: Hepatitis B virus; HCV: Hepatitis C virus; AST: Aspartate aminotransferase; INR: International normalized ratio; CTP: Child-Turcotte-Pugh; MELD: Model for end-stage liver disease; HVPG: Hepatic venous pressure gradient.

Table 2 Groups according to hepatic venous pressure gradient

HVPG (mmHg)	n (%)	Portal hypertension (> 5 mmHg)	CSPH (≥10 mmHg)	SPH (> 12 mmHg)	VSPH (> 20 mmHg)
≤ 5	14 (4)	No (14, 4%)	No (48, 15%)	No (78, 24%)	No (266, 82%)
> 5 to < 10	34 (10)	Yes (312, 96%)
≥ 10 to 12	30 (9)		Yes (278, 85%)
> 12 to ≤ 20	188 (58)			Yes (248, 76%)
> 20	60 (18)				Yes (60, 18%)

CSPH: Clinically significant portal hypertension; SPH: Severe portal hypertension; VSPH: Very severe portal hypertension.

Table 3 Predictive values of transient elastography for the prediction of clinically significant portal hypertension (HVPG ≥ 10 mmHg)

TE cut-off value (mmHg)	CSPH (n)	No CSPH (n)	Total (n)	Sensitivity (95%CI)	Specificity (95%CI)	PPV (95%CI)	NPV (95%CI)	Accuracy (95%CI)	LR+ (95%CI)	LR-(95%CI)
≥ 21.6	219	16	235	79% (74%-83%)	67% (52%-80%)	93% (89%-96%)	35% (25%-46%)	77% (72%-82%)	2.4 (1.6-3.5)	0.3 (0.2-0.4)
< 21.6	59	32	91
Total	278	48	326

TE: Transient elastography; CSPH: Clinically significant portal hypertension; PPV: Positive predictive value; NPV: Negative predictive value; LR+: Likelihood ratio positive; LR-: Likelihood ratio negative.

Table 4 Various studies of the diagnostic performance of transient elastography for clinically significant portal hypertension

Ref.	Place	Year	Number of patients	Correlation coefficient (r) or r2 of TE with HVPG	AUROC (95%CI)	Best cut-off of TE for CSPH
Carrión et al[33]	Spain	2006	124	0.840	0.94	-
Vizzutti et al[14]	Italy	2007	61	0.810	0.99 (0.92-0.99)	13.6 (PPV 97%)
Lemoine et al[34]	France	2008	92	0.530	0.84 (0.80-0.88)	34.9 for alcohol (PPV 98%)
						20.5 for HCV (PPV 88%)
Bureau et al[35]	France	2008	150	0.858	0.945 (0.904-0.987)	21 (PPV 92%)
Sánchez-Conde et al[36]	Spain	2011	38	0.460	0.80 (0.64-0.97)	14 (PPV 84%)
Reiberger et al[13]	Austria	2012	502	0.794	0.817 (0.752-0.891)	18 (PPV 86%)
Llop et al[20]	Spain	2012	97	0.552	0.840 (0.748-0.933)	21 (PPV 81%)
Berzigotti et al[37]	Spain	2013	117	-	0.883 (0.824-0.943)	21.1 (sensitivity 65%)
Hong et al[38]	South Korea	2013	59	0.496	0.851	21.95 (PPV 87%)
Salzl et al[28]	Austria	2014	88	0.765	0.87	16.8 (sensitivity 90%)
Augustin et al[39]	Spain	2014	40	-	-	25
Zykus et al[31]	Lithuania	2015	107	0.750	0.949	17.4 (accuracy 89%)
Procopet et al[32]	Europe	2015	202	-	0.94 (0.89-0.99)	21.1 (accuracy 90%)
	(Multicentric)
Kitson et al[40]	Australia	2015	95	0.380	0.90 (0.83-0.97)	29.0 (PPV 100%)
Elkrief et al[25]	France	2015	79	-	0.78 (0.58-0.98)	65.3 (PPV 100%)
Schwabl et al[41]	Austria	2015	226	0.836 and 0.846	0.957 & 0.962	16.1 (accuracy 89% & 90%)
Hametner et al[29]	Austria	2016	236	-	0.92 (0.86-0.96)	24.8 (PPV 98%)
This study	India	2016	326	0.361	0.740 (0.662-0.818)	21.6 (PPV 93%)
Total			2515			Weighted mean: 21.8

TE: Transient elastography; HVPG: Hepatic venous pressure gradient; AUROC: Area under receiver operating characteristic; CSPH: Clinically significant portal hypertension; PPV: Positive predictive value.