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Comparison of three cut-offs to diagnose clinically significant portal hypertension by liver stiffness in chronic viral liver diseases: a meta-analysis

  • Gastrointestinal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Background

Transient elastography-based liver stiffness value (TE-LSV) has been investigated for assessing clinically significant portal hypertension (CSPH). The aetiology of CSPH is an important factor determining TE-LSV. There is insufficient evidence for selecting cut-off values.

Aims

This study performed a meta-analysis to compare the three most widely used cut-off values (around 13.6 kPa, 18 kPa and 22kPa) of TE-LSV for the diagnosis of CSPH in patients with chronic viral liver disease.

Methods

The PubMed, Ovid, Web of Science and Cochrane Library databases were searched. Diagnostic data for cut-off values around 13.6 kPa, 18 kPa and 22 kPa in each included study were extracted. The bivariate model was performed to estimate pooled sensitivity, specificity, positive likelihood ratio (LR+) and negative likelihood ratio (LR-).

Results

Eleven studies assessing 910 patients were included in this meta-analysis. Pooled sensitivities of cut-off values around 13.6 kPa, 18 kPa and 22 kPa were 0.96 (95% CI 0.93–0.97), 0.85 (0.81–0.89) and 0.74 (0.66–0.80), respectively; pooled specificities were 0.60 (0.47–0.75), 0.80 (0.71-0.87) and 0.94 (0.86–0.97), respectively. Pooled LR+ values were 2.4 (1.6–3.7), 4.4 (2.9–6.8) and 11.5 (5.5–23.5) for cut-off values around 13.6 kPa, 18 kPa and 22 kPa, respectively, for pooled LR- values of 0.07 (0.04–0.13), 0.17 (0.12–0.25) and 0.28 (0.22–0.36), respectively.

Conclusion

Cut-off values around 13.6 kPa (high sensitivity) and 22 kPa (high specificity) could be used as screening and confirmation tools, respectively, in the diagnosis of CSPH. Overall, the cut-off value around 22 kPa showed the best performance.

Key Points

  • Transient elastography-based liver stiffness could be used to diagnose portal hypertension.

  • Comparison of certain cut-off values would provide more information for clinical decision-making.

  • Cut-off around 13.6 kPa was able to exclude clinically significant portal hypertension (CSPH) effectively.

  • Cut-off around 22 kPa was able to confirm CSPH effectively.

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Abbreviations

BMI:

Body mass index

CI:

Confidence interval

CLD:

Chronic liver disease

CSPH:

Clinically significant portal hypertension

HSROC:

Hierarchical Summary Receiver Operating Characteristic

HVPG:

Hepatic venous pressure gradient

LR-:

Negative likelihood ratio

LR+:

Positive likelihood ratio

LSV:

Liver stiffness value

TE:

Transient elastography

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Acknowledgements

We thank C. Bureau for providing individual data in our study, and we thank all the physicians who contributed data to this study.

Funding

This study has received funding by National Natural Science Foundation, China No. 81671702 and No. 81571697.

Author information

Author notes

  1. Jinzhen Song and Zida Ma contributed equally to this study.

Authors and Affiliations

  1. Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, China

    Jinzhen Song, Yan Luo & Qiang Lu

  2. Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Chengdu, China

    Zida Ma

  3. Laboratory of Clinical Ultrasound Imaging Drug Research, West China Hospital of Sichuan University, Chengdu, China

    Jianbo Huang

  4. Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, China

    Shiyu Liu

  5. Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria

    Philipp Schwabl

  6. Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania

    Romanas Zykus

  7. Department of Gastroenterology, Sir Ganga Ram Hospital, New Delhi, India

    Ashish Kumar

  8. Department of Gastroenterology, Alfred Hospital, Melbourne, Australia

    Matthew Kitson

Authors
  1. Jinzhen Song
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  2. Zida Ma
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  5. Yan Luo
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Corresponding authors

Correspondence to Yan Luo or Qiang Lu.

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Guarantor

The scientific guarantor of this publication is Luo Yan.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was not required for this study because our study was a meta-analysis.

Ethical approval

Institutional Review Board approval was not required because our study was a meta-analysis.

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• Performed at one institution

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Song, J., Ma, Z., Huang, J. et al. Comparison of three cut-offs to diagnose clinically significant portal hypertension by liver stiffness in chronic viral liver diseases: a meta-analysis. Eur Radiol 28, 5221–5230 (2018). https://doi.org/10.1007/s00330-018-5478-z

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  • DOI: https://doi.org/10.1007/s00330-018-5478-z

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