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Updated: Jan 8, 2026
Measurement of the Hepatic Venous Pressure Gradient and Transjugular Liver Biopsy
Published on: June 18, 2020
Noninvasive Markers Associated With Portal Hypertension and Varices in Patients With Noncirrhotic Portal Hypertension
Harish Gopalakrishna1, Maria Mironova1, Nehna Abdul Majeed1
1Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA.
Insights
A new noninvasive model combining liver stiffness (LSM) and platelet count can accurately identify patients with noncirrhotic portal hypertension (NCPH) and varices. This approach offers a promising tool for diagnosing PH and varices in NCPH patients.
Area of Science:
- Hepatology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Noncirrhotic portal hypertension (NCPH) is a group of disorders affecting the hepatic portosinusoidal vasculature, leading to portal hypertension (PH).
- Unlike cirrhosis, NCPH lacks established noninvasive criteria for diagnosing PH and associated varices.
Purpose of the Study:
- To develop and evaluate a noninvasive model for diagnosing portal hypertension (PH) and varices in patients with noncirrhotic portal hypertension (NCPH).
Main Methods:
- Prospective cohort study including patients with NCPH undergoing transjugular liver biopsy.
- Liver stiffness (LSM) measured by transient elastography, laboratory values, and imaging data were collected.
- Logistic regression and classification tree approaches identified predictors and cutoff values for PH and varices.
Main Results:
- A combined model of LSM and platelet count demonstrated high accuracy in predicting PH (AUC 96%) and varices (AUC 92%).
- A stepwise model using platelet count ≤140 × 10^9/L and LSM ≤7 kPa achieved 100% sensitivity and negative predictive value for detecting PH and varices.
- This noninvasive model showed 90% accuracy for PH and 81% for varices detection.
Conclusions:
- A noninvasive model integrating LSM and platelet count can effectively aid in identifying NCPH patients with PH and varices.
- This model requires further validation in an independent cohort before widespread clinical application.
Introduction:
Noncirrhotic portal hypertension (NCPH) refers to a diverse group of disorders that affects the hepatic portosinusoidal vascular system resulting in portal hypertension (PH). Unlike cirrhosis, there are no noninvasive criteria to diagnose PH and varices in NCPH.
Methods:
A prospective cohort of patients with NCPH who had transjugular liver biopsy, liver stiffness (LSM) measured using transient elastography, and laboratory and imaging data were included. PH was defined by the presence of one among the following-varices on endoscopy, portosystemic collaterals, or ascites on imaging. Logistic regression was used to identify predictors. The classification tree approach was used to identify cutoff values for the stepwise decision model.
Results:
Of the 59 patients, 41 (69%) had PH and 36 (62%) had varices. LSM was higher in patients with PH (11.5 kPa vs 5.7 kPa, P < 0.01) and varices (12 kPa vs 5.9 kPa, P < 0.01). Platelet count was lower in patients with PH (79 vs 218 × 10 9 /L, P < 0.01) and varices (75 vs 209 × 10 9 /L, P < 0.01). Multivariate analysis combining LSM and platelet count predicts PH (area under receiver operating characteristic 96% [91%-99%]) and varices (area under receiver operating characteristic 92% [85%-99%]). A stepwise model combining platelet 140 × 10 9 /L and LSM 7 kPa performed with a sensitivity of 100%, negative predictive value of 100%, and accuracy of 90% to detect PH. The same model performed with sensitivity of 100%, negative predictive value of 100%, and accuracy of 81% to detect varices.
Discussion:
Noninvasive model combining LSM with platelet count can aid in identifying NCPH patients with PH and varices. However, this model requires validation in an independent cohort.
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