Reliability of Transient Elastography-Based Liver Stiffness for Diagnosing Portal Hypertension in Patients with Alcoholic Liver Disease: A Diagnostic Meta-Analysis with Specific Cut-Off Values

Abstract

Background Transient elastography-based liver stiffness value (TE-LSV) has been studied for the diagnosis of portal hypertension. Liver stiffness is influenced by the disease etiology. We aimed to perform a meta-analysis to determine the performance of TE-LSV for diagnosing portal hypertension in patients with alcoholic liver disease (ALD).

Methods We searched PubMed, Web of Science, Ovid and Cochrane library. A bivariate model was used to compute sensitivity and specificity. A random effects model was used to pool diagnostic odds ratios.

Results 9 studies with 679 patients were included. The pooled sensitivity and specificity based on a cut-off value around 21.8 kPa for clinically significant portal hypertension (CSPH) were 0.89 (95 % confidence interval (CI), 0.83–0.93) and 0.71(95 % CI, 0.64–0.78), respectively. For severe portal hypertension (SPH), the pooled sensitivity and specificity for a cut-off value around 29.1 kPa were 0.88 (95 % CI, 0.83–0.92) and 0.74 (95 % CI, 0.67–0.81), respectively.

Conclusion TE-LSV showed good performance for diagnosing portal hypertension in patients with ALD. The optimal cut-off value for CSPH and SPH was around 21.8 kPa and 29.1 kPa, respectively, and these two cut-off values showed good sensitivity and modest specificity. The etiology should be clear before using TE-LSV for portal hypertension.

Zusammenfassung

Hintergrund Der diagnostische Wert der Bestimmung der auf transienter Elastografie basierten Lebersteifigkeit (TE-LSV) wurde bei portaler Hypertension untersucht. Die Lebersteifigkeit wird durch die Erkrankungsursache beeinflusst. Unser Ziel war die Durchführung einer Meta-Analyse zur Ermittlung der diagnostischen Aussagekraft der TE-LSV für die Diagnose von portaler Hypertension bei Patienten mit alkoholischer Lebererkrankung (alcoholic liver disease, ALD).

Methoden Wir durchsuchten PubMed, Web of Science, Ovid und die Cochrane-Bibliothek. Ein bivariates Modell wurde für die Berechnung von Sensitivität und Spezifität verwendet. Ein Random-Effects-Modell wurde angewandt, um die diagnostischen Odds-Ratios zu poolen.

Ergebnisse Es wurden 9 Studien mit 679 Patienten eingeschlossen. Für eine klinisch signifikante portale Hypertension (CSPH) basierend auf einem Cut-off-Wert von etwa 21,8 kPa betrugen die gepoolte Sensitivität 0,89 (95 % Konfidenzintervall (CI), 0,83–0,93) und die gepoolte Spezifität 0,71 (95 % CI, 0,64–0,78). Bei schwerer portaler Hypertension (SPH) betrugen die gepoolte Sensitivität 0,88 (95 % CI, 0,83–0,92) und die Spezifität 0,74 (95 % CI, 0,67–0,81) für einen Cut-off-Wert um 29,1 kPa.

Schlussfolgerung TE-LSV zeigte eine gute diagnostische Leistung bezüglich der portalen Hypertension bei Patienten mit ALD. Der optimale Cut-off-Wert für CSPH betrug etwa 21,8 kPa und der für SPH 29,1 kPa; beide Werte zeigten eine gute Sensitivität und mäßige Spezifität. Eine Abklärung der Ätiologie vor Durchführung der TE-LSV bei portaler Hypertonie sollte erfolgen.

Key words

portal hypertension - alcoholic liver disease - elastography - abdomen

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