Restricted accessResearch articleFirst published online 2026
Accuracy and influencing factors of hepatic venous pressure gradient,spleen stiffness and liver stiffness in the detection of portal hypertension with liver cirrhosis
To assess the accuracy of hepatic venous pressure gradient (HVPG), spleen stiffness (SS) and liver stiffness (LS) for detecting portal hypertension (PH).
Methods
We measured HVPG, SS, LS and portal pressure gradient (PPG) in 104 patients with liver cirrhosis from April 2019 to April 2024. Correlations between these parameters and PH were analyzed using Pearson correlation or Spearman's rank correlation test appropriate. Diagnostic performance was evaluated by receiver operating characteristic (ROC) curve analysis. Multiple linear regression analysis was to identify factors independently associated with HVPG, SS and LS.
Results
HVPG and SS were significantly correlated with PPG (p < 0.005), whereas LS showed no significant correlation with PPG (p = 0.532). For prediction of PH defined by PPG≥12, 20 and 25 mmHg, areas under the ROC curve (AUC) of HVPG were 0.983, 0.875 and 0.680, and the AUC of SS were 0.764, 0.922 and 0.700, respectively. Multiple linear regression analysis showed that factors independently associated with HVPG included aspartate aminotransferase (AST), total bilirubin (TBIL) and previous bleeding, while those associated with SS were white blood cell count (WBC) and Model for End-Stage Liver Disease-Sodium (MELD-Na) score.
Conclusion
HVPG and SS had favorable diagnostic performance for identifying PH in patients with liver cirrhosis.
IpshitaGJohnEPriscillaM, et al.Diagnosing portal hypertension with noninvasive subharmonic pressure estimates from a US contrast agent. Radiology2021; 298: 104–111.
2.
ManliWLiliWJieyangJ, et al.Liver stiffness measured with two-dimensional shear-wave elastography is predictive of liver-related events in patients with chronic liver disease due to hepatis B viral infection. Radiology2020; 295: 353–360.
3.
MauroGJohannesDAlessiaV, et al.Predicting response to non-selective beta-blockers with liver-spleen stiffness and heart rate in patients with liver cirrhosis and high-risk varices. Hepatol Int2024; 19: 0.
4.
MatthiasBPaulMJensT, et al.Spleen stiffness is positively correlated with HVPG and decreases significantly after TIPS implantation. Dig Liver Dis2018; 50: 54–60.
5.
ChuanLRuoyangSSiningW, et al.The presence of ascites affects the predictive value of HVPG on early rebleeding in patients with cirrhosis. Gastroenterol Res Pract2020; 2020: 1329857.
6.
JungEMKaiserUHerrW, et al.Novel high-resolution contrast agent ultrasound techniques HiFR CEUS and SR CEUS in combination with shear wave elastography, fat assessment and viscosity of liver parenchymal changes and tumors. Clin Hemorheol Microcirc2024; 86: 263–273.
7.
HoriaSCorinaRMonicaL-P, et al.Liver stiffness assessed by ultrasound shear wave elastography from general electric accurately predicts clinically significant portal hypertension in patients with advanced chronic liver disease. Ultraschall Med2020; 41: 526–533.
8.
LaureEPierre-EmmanuelRMaximeR, et al.Prospective comparison of spleen and liver stiffness by using shear-wave and transient elastography for detection of portal hypertension in cirrhosis. Radiology2015; 275: 589–598.
9.
HuijunD. Image features of dynamic enhanced computed tomography scanning combined with digestive endoscopy in the treatment of gastroesophageal varices and nursing of esophagogastric gastric varices bleeding. Comput Math Methods Med2022; 2022: 7926114.
10.
DietrichCFBamberJBerzigottiA, et al.EFSUMB Guidelines and recommendations on the clinical use of liver ultrasound elastography, update 2017 (long version). Ultraschall Med2017; 38: 48.
11.
LemoineMKatsahianSZiolM, et al.Liver stiffness measurement as a predictive tool of clinically significant portal hypertension in patients with compensated hepatitis C virus or alcohol-related cirrhosis. Aliment Pharmacol Ther2008; 28: 1102–1110.
12.
BoschJAbraldesJGBerzigottiA, et al.The clinical use of HVPG measurements in chronic liver disease. Nat Rev Gastroenterol Hepatol2009; 6: 573–582.
13.
YifanLQingkunSZhendongY, et al.Correlation between hepatic venous pressure gradient and portal venous pressure gradient in hepatitis B cirrhosis with different hepatic veins anatomy. Eur J Radiol2022; 155: 110463.
14.
JonathanVChristopherSJosephS, et al.Hepatic venous pressure gradient correlates with advanced hepatic fibrosis: a retrospective review. Abdom Radiol (NY)2017; 42: 2609–2614.
15.
BingtianDYupingCGuorongL, et al.Quantitative assessment of portal hypertension by two-dimensional shear wave elastography in rat models of nonalcoholic fatty liver disease: comparison with four composite scores. Front Med (Lausanne)2022; 9: 844558.
16.
Yu-LiZHongDTian-TianF, et al.Portal hypertension in hepatitis B-related cirrhosis: diagnostic accuracy of liver and spleen stiffness by 2-D shear-wave elastography. Hepatol Res2019; 49: 540–549.
17.
ThomasR. The value of liver and spleen stiffness for evaluation of portal hypertension in compensated cirrhosis. Hepatol Commun2022; 6: 950–964.
18.
XiaolongQWeiminAFuquanL, et al.Virtual hepatic venous pressure gradient with CT angiography (CHESS 1601): a prospective multicenter study for the noninvasive diagnosis of portal hypertension. Radiology2019; 290: 370–377.
19.
LunovaMFrankovaSGottfriedovaH, et al.Portal hypertension is the main driver of liver stiffness in advanced liver cirrhosis. Physiol Res2021; 70: 563–577.
20.
KönigshoferPHoferBSBrusilovskayaK, et al.Distinct structural and dynamic components of portal hypertension in different animal models and human liver disease etiologies. Hepatology2022; 75: 610–622.
21.
YaraşSSezginOÜçbilekE, et al.Significant decrease in liver stiffness detected by two dimensional shear-wave elastography after treatment with direct-acting antiviral agents in patients with chronic hepatitis C. Turk J Gastroenterol2020; 31: 142–147.
22.
Chia-YenDTzu-JungFWei-WenH, et al.The determinants of liver fibrosis in patients with nonalcoholic fatty liver disease and type 2 diabetes Mellitus. Biomedicines2022; 10: 1487.
23.
LeWYueminFXiaowenM, et al.Diagnostic efficacy of noninvasive liver fibrosis indexes in predicting portal hypertension in patients with cirrhosis. PLoS One2017; 12: e0182969.
24.
Ramírez-MejíaMMCastillo-CastañedaSMPalSC, et al.The multifaceted role of bilirubin in liver disease: a literature review. J Clin Transl Hepatol2024; 12: 939–948.
25.
RamanathanSKhandelwalNKalraN, et al.Correlation of HVPG level with ctp score, MELD score, ascites, size of varices, and etiology in cirrhotic patients. Saudi J Gastroenterol2016; 22: 109–115.
26.
KimTYSukKTJeongSW, et al.The new cutoff value of the hepatic venous pressure gradient on predicting long-term survival in cirrhotic patients. J Korean Med Sci2019; 34: e223.
27.
SathawaneAKhobragadeHPalS. Correlation of hepatic venous pressure gradient level with clinical and endoscopic parameters in decompensated chronic liver disease. Cureus2023; 15: e51154.
28.
LiaBRobertoCFabrizioM, et al.Hepatic venous pressure gradient determination in patients with hepatitis C virus-related and alcoholic cirrhosis. Eur J Gastroenterol Hepatol2003; 15: 1085–1089.
29.
McCormickPADermotMJamesD, et al.Patterns of splenic arterial enhancement on computed tomography are related to changes in portal venous pressure. Eur J Gastroenterol Hepatol2019; 31: 352–356.
30.
YunfuLHongfeiWWan YeeL, et al.Impact of total splenectomy on peripheral lymphocytes and their subsets in patients with hypersplenism associated with cirrhotic portal hypertension. Sci Rep2021; 11: 21246.
31.
Ki TaeSChang HoonKSeung HaP, et al.Comparison of hepatic venous pressure gradient and two models of end-stage liver disease for predicting the survival in patients with decompensated liver cirrhosis. J Clin Gastroenterol2012; 46: 880–886.
32.
YunaKKyungheeKInsilJ. Analysis of mortality prognostic factors using model for end-stage liver disease with incorporation of serum-sodium classification for liver cirrhosis complications: a retrospective cohort study. Medicine (Baltimore)2019; 98: e17862.
