Detection of early portal hypertension with routine data and liver stiffness in patients with asymptomatic liver disease: A prospective study

Background & Aims Detecting portal hypertension (PH) before the development of varices is important for prognosis and for designing interventional studies. None of the available strategies is used in practice. We evaluated a sequential screening-diagnostic strategy based on clinical data and transient elastography (TE) to detect PH in asymptomatic outpatients with liver disease. Methods Consecutive patients with chronic liver disease and no previous diagnosis of PH were screened by TE. Patients with liver stiffness (LS) ⩾13.6kPa were further evaluated by endoscopy and hepatic venous pressure gradient (HVPG). For analysis, patients were classified in 3 groups: group A, platelets ⩾150,000/mm 3 , normal abdominal ultrasound; group B, platelets 3 , normal ultrasound; group C, platelets 3 , abnormal ultrasound (splenomegaly, nodular liver surface). Results 250 patients were evaluated (69% group A, 20% group B, 11% group C). In 9% elastography was non-valid. LS ⩾13.6 was found in 54 patients (8% A, 43% B, and 81% C, p 5mmHg) and 65% clinically significant PH (CSPH, HVPG ⩾10). Only 3 patients, all from group A, had HVPG Conclusions A simple strategy based on routine clinical data and TE could be useful to detect early PH among asymptomatic patients with chronic liver disease.