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Hepatic venous pressure gradient as a predictor of fibrosis in chronic liver disease because of hepatitis B virus


Dr Shiv K. Sarin, MD, DM FNA, FNASc, Room No. 201, Academic Block, Department of Gastroenterology, G. B. Pant Hospital, New Delhi 110002, India
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Background: Liver biopsy has been considered to be a gold standard for assessing hepatic fibrosis. Sample variability, interobserver variability and step-wise evaluation limit its use. Hepatic venous pressure gradient (HVPG) correlates with hepatic fibrosis in chronic liver disease (CLD) because of hepatitis C.

Aim: To evaluate the utility of HVPG for assessing hepatic fibrosis in patients with hepatitis B virus (HBV)-related CLD.

Patients and Methods: Sixty-one patients with HBV-related CLD who underwent both liver biopsy and hepatic haemodynamic studies were studied.

Results: Forty-nine (80.3%) patients had clinically significant portal hypertension (PHT) (HVPG≥10 mmHg), 39 (63.9%) severe PHT (i.e. HVPG≥12 mmHg), six (9.8%) HVPG≤5 mmHg and another six (9.8%) had preclinical PHT (i.e. HVPG>5 but <10 mmHg). A positive correlation between HVPG and fibrosis score was found (r=0.436, P<0.001). In patients with HVPG<10 or <12 mmHg there was a significant correlation with fibrosis score (r=0.603, P=0.029 and r=0.887, P<0.001 respectively). A positive correlation also existed in patients with HVPG≥10 mmHg and in patients with HVPG≥12 mmHg (r=0.512, P≤0.001 and r=0.543, P<0.001 respectively). Receiver operating characteristic curve of HVPG for the prediction of advanced fibrosis (stage≥3) had an area under curve of 0.906. HVPG value above 13.0 mmHg had a sensitivity of 79% and a specificity of 89% for predicting advanced fibrosis on histology.

Conclusions: HVPG correlates well with the degree of histological fibrosis in patients with HBV-related CLD.