Novel inflammatory biomarkers of portal pressure in compensated cirrhotic patients.Buck M, Garcia-Tsao G, Groszmann RJ, Stalling C, Grace ND, Burroughs AK, Patch D, Matloff DS, Clopton P, Chojkier M. Hepatology. 2013 Oct 1. [Epub ahead of print]
The rationale for screening inflammatory serum biomarkers of the hepatic vein pressure gradient (HVPG) is based on the fact that portal hypertension is pathogenically related to liver injury and fibrosis, and that in turn these are associated with the activation of inflammatory pathways.
This was a nested cohort study in the setting of a randomized, clinical trial to assess the development of gastroesophageal varices (GEV) (N Engl J Med. 353:2254; 2005). Patients had cirrhosis and portal hypertension but did not have GEV. A total of 90 patients that had baseline day-1 sera available were enrolled into the present study. The objective of this study was to determine whether inflammatory biomarkers in conjunction with clinical parameters could be used to develop a predictive paradigm for HVPG. The correlations between HVPG and IL-1β (P= 0.0052); IL-1R-alpha (P= 0.0085); Fas-R (P=0.0354) and serum VCAM-1 (P= 0.0007) were highly significant. By using multivariate logistic regression analysis and selected parameters (TGFβ; HSP-70; at-risk alcohol use; and Child-Pugh B score) we could exclude HVPG equal or > 12 mmHg with 86 % accuracy ( 95% Confidence Interval; 67.78 to 96.16 %) and the sensitivity was 87.01 % (95% Confidence Interval; 69.68 to 96.34 %). Therefore, the composite test could identify 86 % of compensated cirrhotic patients with HVPG below 12 mmHg and prevent unnecessary esophagogastroduodenoscopy with its associated morbidity and costs in these patients. Our diagnostic test was not efficient in predicting HVPG equal or >12 mmHg. Conclusion: A blood test for HVPG could be performed in cirrhotic patients to prevent unnecessary esophagogastroduodenoscopy.