Comparison of three cut-offs to diagnose clinically significant portal hypertension by liver stiffness in chronic viral liver diseases: a meta-analysis.

Autor: Song, Jinzhen, Ma, Zida, Huang, Jianbo, Liu, Shiyu, Luo, Yan, Lu, Qiang, Schwabl, Philipp, Zykus, Romanas, Kumar, Ashish, Kitson, Matthew
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Zdroj: European Radiology; Dec2018, Vol. 28 Issue 12, p5221-5230, 10p, 1 Diagram, 5 Charts, 2 Graphs
Abstrakt: Background: Transient elastography-based liver stiffness value (TE-LSV) has been investigated for assessing clinically significant portal hypertension (CSPH). The aetiology of CSPH is an important factor determining TE-LSV. There is insufficient evidence for selecting cut-off values.Aims: This study performed a meta-analysis to compare the three most widely used cut-off values (around 13.6 kPa, 18 kPa and 22kPa) of TE-LSV for the diagnosis of CSPH in patients with chronic viral liver disease.Methods: The PubMed, Ovid, Web of Science and Cochrane Library databases were searched. Diagnostic data for cut-off values around 13.6 kPa, 18 kPa and 22 kPa in each included study were extracted. The bivariate model was performed to estimate pooled sensitivity, specificity, positive likelihood ratio (LR+) and negative likelihood ratio (LR-).Results: Eleven studies assessing 910 patients were included in this meta-analysis. Pooled sensitivities of cut-off values around 13.6 kPa, 18 kPa and 22 kPa were 0.96 (95% CI 0.93-0.97), 0.85 (0.81-0.89) and 0.74 (0.66-0.80), respectively; pooled specificities were 0.60 (0.47-0.75), 0.80 (0.71-0.87) and 0.94 (0.86-0.97), respectively. Pooled LR+ values were 2.4 (1.6-3.7), 4.4 (2.9-6.8) and 11.5 (5.5-23.5) for cut-off values around 13.6 kPa, 18 kPa and 22 kPa, respectively, for pooled LR- values of 0.07 (0.04-0.13), 0.17 (0.12-0.25) and 0.28 (0.22-0.36), respectively.Conclusion: Cut-off values around 13.6 kPa (high sensitivity) and 22 kPa (high specificity) could be used as screening and confirmation tools, respectively, in the diagnosis of CSPH. Overall, the cut-off value around 22 kPa showed the best performance.Key Points: Transient elastography-based liver stiffness could be used to diagnose portal hypertension.Comparison of certain cut-off values would provide more information for clinical decision-making.Cut-off around 13.6 kPa was able to exclude clinically significant portal hypertension (CSPH) effectively.Cut-off around 22 kPa was able to confirm CSPH effectively. [ABSTRACT FROM AUTHOR]
Databáze: Complementary Index
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