Hepatic venous pressure gradient as a predictor of fibrosis in chronic liver disease because of hepatitis B virus

Abstract

Background: Liver biopsy has been considered to be a gold standard for assessing hepatic fibrosis. Sample variability, interobserver variability and step‐wise evaluation limit its use. Hepatic venous pressure gradient (HVPG) correlates with hepatic fibrosis in chronic liver disease (CLD) because of hepatitis C. Aim: To evaluate the utility of HVPG for assessing hepatic fibrosis in patients with hepatitis B virus (HBV)‐related CLD. Patients and Methods: Sixty‐one patients with HBV‐related CLD who underwent both liver biopsy and hepatic haemodynamic studies were studied. Results: Forty‐nine (80.3%) patients had clinically significant portal hypertension (PHT) (HVPG≥10 mmHg), 39 (63.9%) severe PHT (i.e. HVPG≥12 mmHg), six (9.8%) HVPG≤5 mmHg and another six (9.8%) had preclinical PHT (i.e. HVPG>5 but r=0.436, Pr=0.603, P=0.029 and r=0.887, Pr=0.512, P≤0.001 and r=0.543, P<0.001 respectively). Receiver operating characteristic curve of HVPG for the prediction of advanced fibrosis (stage≥3) had an area under curve of 0.906. HVPG value above 13.0 mmHg had a sensitivity of 79% and a specificity of 89% for predicting advanced fibrosis on histology. Conclusions: HVPG correlates well with the degree of histological fibrosis in patients with HBV‐related CLD.