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

Abstract

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.