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Hepatic venous pressure gradient evaluates the Scheuer stage of liver fibrosis by transjugular liver biopsy: a multicenter study

  • Author Footnotes
    ∗ These authors contributed equally to this work.
    Haijun Zhang
    Footnotes
    ∗ These authors contributed equally to this work.
    Affiliations
    Department of Anesthesiology and Operating Theater, The First Hospital of Lanzhou University, Lanzhou 730000, China
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  • Author Footnotes
    ∗ These authors contributed equally to this work.
    Zhidong Wang
    Footnotes
    ∗ These authors contributed equally to this work.
    Affiliations
    Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, China
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  • Author Footnotes
    ∗ These authors contributed equally to this work.
    Xiaoquan Wei
    Footnotes
    ∗ These authors contributed equally to this work.
    Affiliations
    Department of E.N.T., Gansu Provincial Hospital, Lanzhou 730000, China
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  • Hao Wu
    Affiliations
    Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, China
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  • Lei Li
    Affiliations
    Interventional Radiology Department, The First Hospital of Lanzhou University, Lanzhou 730000, China
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  • Wuhua Guo
    Affiliations
    Department of Intervention, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, China
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  • Ling Li
    Affiliations
    Department of Intervention, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, China
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  • Ruihang Wang
    Affiliations
    Department of Radiology, Tianjin Second People’s Hospital, Tianjin 300180, China
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  • Chao Yang
    Affiliations
    Department of Gastroenterology and Hepatology, The Third Central Hospital of Tianjin, Tianjin 300170, China
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  • Xuehua Yan
    Affiliations
    Department of Hepatology, The 2nd People’s Hospital of Lanzhou City, Lanzhou 730046, China
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  • Fang Wang
    Affiliations
    Department of Pathology, The First Hospital of Lanzhou University, Lanzhou, 730000, China
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  • Jun Yan
    Affiliations
    The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730000, China

    The Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, China
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  • Xun Li
    Correspondence
    Correspondence: The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730000, China.
    Affiliations
    Department of Anesthesiology and Operating Theater, The First Hospital of Lanzhou University, Lanzhou 730000, China

    The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730000, China

    The Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, China

    Key Laboratory of Biotherapy and Regenerative Medicine of Gansu Province, Lanzhou, 730000, China
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  • Author Footnotes
    ∗ These authors contributed equally to this work.
Published:February 13, 2023DOI:https://doi.org/10.1016/j.hpb.2023.02.006

      Abstract

      Background

      Hepatic venous pressure gradient (HVPG) is the criterion for assessing sinusoidal portal hypertension. Using HVPG to assess the degree of liver fibrosis by transjugular liver biopsy (TJLB) is still being explored, as no data has been shown that portal hypertension may already be present in patients with advanced hepatic fibrosis (Scheuer stage ≥ S3). The objective of this study was to observe whether portal hypertension exists before progressing to cirrhosis (Scheuer stage = S4).

      Methods

      Fifty patients who underwent TJLB and HVPG were enrolled. The correlation between Scheuer stage and HVPG was analyzed using the Pearson correlation coefficient, and the ROC curve predicted the diagnostic value of HVPG in patients with hepatic fibrosis.

      Results

      The Scheuer stage and HVPG significantly correlated (r = 0.654, p < 0.001). The AUC of HVPG in predicting advanced liver fibrosis was 0.896, and of cirrhosis was 0.810. There were 45 patients with portal hypertension (HVPG> 5 mmHg), 12 with S3, 29 with S4; There were 42 patients with CSPH (HVPG≥ 10 mmHg), 11 with S3, and 29 with S4.

      Conclusion

      HVPG is valuable in evaluating the Scheuer stage of liver fibrosis in patients with TJLB. Portal hypertension might already exist before the progression to cirrhosis in some patients.
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      References

        • Kisseleva T.
        • Brenner D.
        Molecular and cellular mechanisms of liver fibrosis and its regression.
        Nat Rev Gastroenterol Hepatol. 2021; 18: 151-166
        • Fernandez M.
        Molecular pathophysiology of portal hypertension.
        Hepatology. 2015; 61: 1406-1415
        • Khalifa A.
        • Rockey D.C.
        The utility of liver biopsy in 2020.
        Curr Opin Gastroenterol. 2020; 36: 184-191
      1. Consensus on the diagnosis and therapy of hepatic fibrosis in.
        Zhonghua Gan Zang Bing Za Zhi. 2019; 27: 657-667
        • Ma F.Q.
        • Li W.Z.
        • Li P.J.
        • Liu M.Y.
        • Xue H.
        Analysis of 14 cases of transjugular liver biopsy.
        Zhonghua Gan Zang Bing Za Zhi. 2019; 27: 799-801
        • Franchis R de
        • Bosch J.
        • Garcia-Tsao G.
        • Reiberger T.
        • Ripoll C.
        Baveno VII - renewing consensus in portal hypertension.
        J Hepatol. 2022; 76: 959-974
      2. Consensus on clinical application of hepatic venous pressure gradient in China (2018).
        Zhonghua Gan Zang Bing Za Zhi. 2018; 26: 801-812
        • Kumar M.
        • Kumar A.
        • Hissar S.
        • Jain P.
        • Rastogi A.
        • Kumar D.
        • et al.
        Hepatic venous pressure gradient as a predictor of fibrosis in chronic liver disease because of hepatitis B virus.
        Liver Int. 2008; 28: 690-698
        • Blasco A.
        • Forns X.
        • Carrión J.A.
        • García-Pagán J.C.
        • Gilabert R.
        • Rimola A.
        • et al.
        Hepatic venous pressure gradient identifies patients at risk of severe hepatitis C recurrence after liver transplantation.
        Hepatology. 2006; 43: 492-499
        • Vincent J.K.
        • Stark C.
        • Shields J.T.
        • Bhave A.D.
        • Morris C.S.
        Hepatic venous pressure gradient correlates with advanced hepatic fibrosis: a retrospective review.
        Abdom Radiol (NY). 2017; 42: 2609-2614
        • Samonakis D.N.
        • Cholongitas E.
        • Thalheimer U.
        • Kalambokis G.
        • Quaglia A.
        • Triantos C.K.
        • et al.
        Hepatic venous pressure gradient to assess fibrosis and its progression after liver transplantation for HCV cirrhosis.
        Liver Transplant. 2007; 13: 1305-1311
        • Zhang H.
        • Yang L.
        • Yu Z.
        • Li D.
        • Li L.
        • Li S.
        • et al.
        Impact of fentanyl analgesia on the accuracy of HVPG measurements in patients with cirrhosis: a prospective, multicenter study.
        Hepatol Commun. 2023; 7e0002
        • Tapper E.B.
        • Lok A.S.-F.
        Use of liver imaging and biopsy in clinical practice.
        N Engl J Med. 2017; 377: 756-768
        • Cholongitas E.
        • Burroughs A.K.
        Liver: transjugular liver biopsy yields high-quality samples.
        Nat Rev Gastroenterol Hepatol. 2012; 9: 491-492
        • Ebel N.H.
        • Carlin K.
        • Shaffer M.L.
        • Shivaram G.
        • Hawkins M.
        • Lane E.R.
        • et al.
        Hepatic venous pressure gradient measurements in children: correlation with hepatic histology and clinical indicators of portal hypertension.
        J Pediatr Gastroenterol Nutr. 2019; 68: 788-792
        • Ebrahimi F.
        • Semela D.
        • Heim M.
        Impact of propofol sedation on the diagnostic accuracy of hepatic venous pressure gradient measurements in patients with cirrhosis.
        Hepatol Int. 2022; 16: 817-823
        • Janik M.K.
        • Kruk B.
        • Szczepankiewicz B.
        • Kostrzewa K.
        • Raszeja-Wyszomirska J.
        • Górnicka B.
        • et al.
        Measurement of liver and spleen stiffness as complementary methods for assessment of liver fibrosis in autoimmune hepatitis.
        Liver Int. 2021; 41: 348-356
        • Sato N.
        • Kenjo A.
        • Nishimagi A.
        • Kimura T.
        • Okada R.
        • Ishigame T.
        • et al.
        Accuracy comparison of MR elastography and biological markers in detecting liver fibrosis and predicting postoperative ascites.
        HPB. 2021; 23: 1383-1391
        • Ferral H.
        • Fimmel C.J.
        • Sonnenberg A.
        • Alonzo M.J.
        • Aquisto T.M.
        Transjugular liver biopsy with hemodynamic evaluation: correlation between hepatic venous pressure gradient and histologic diagnosis of cirrhosis.
        J Clin Imaging Sci. 2021; 11: 25
        • Namisaki T.
        • Moriya K.
        • Kitade M.
        • Kawaratani H.
        • Takeda K.
        • Okura Y.
        • et al.
        Clinical significance of the Scheuer histological staging system for primary biliary cholangitis in Japanese patients.
        Eur J Gastroenterol Hepatol. 2017; 29: 23-30
        • Papatheodoridi M.
        • Hiriart J.B.
        • Lupsor-Platon M.
        • Bronte F.
        • Boursier J.
        • Elshaarawy O.
        • et al.
        Refining the Baveno VI elastography criteria for the definition of compensated advanced chronic liver disease.
        J Hepatol. 2021; 74: 1109-1116
        • Sun Y.
        • Zhou J.
        • Wu X.
        • Chen Y.
        • Piao H.
        • Lu L.
        • et al.
        Quantitative assessment of liver fibrosis (qFibrosis) reveals precise outcomes in Ishak “stable” patients on anti-HBV therapy.
        Sci Rep. 2018; 8: 2989