Objective:

To evaluate non-invasive tests for identifying portal hypertension and determining the need for further testing.

Approach:

• Review of Non-invasive Methods: The review assessed alternatives to hepatic venous pressure gradient (HVPG) measurement, including elastography, blood-based biomarkers, imaging techniques, and AI models.

Key Findings:

• Transient elastography is a well-established method for measuring liver stiffness.
• Current Baveno VII criteria use liver stiffness and platelet count to estimate the likelihood of clinically significant portal hypertension (CSPH). A liver stiffness measurement of 15 kPa or less with a platelet count of at least 150 × 10^9/L can rule out CSPH, whereas liver stiffness of at least 25 kPa can rule it in.
• Approximately 40 to 60 percent of patients may fall into an indeterminate range using current criteria.
• Adding spleen stiffness measurement can reduce the indeterminate range to about 7 to 15 percent.
• Routine laboratory tests may enhance assessment when elastography is unavailable.
• AI models have shown high diagnostic accuracy but require further validation.

Interpretation:

A stepwise approach using non-invasive tests for initial risk assessment is suggested, with HVPG remaining important for definitive measurements.

Limitations:

• Many AI models require larger, multicenter studies and standardized protocols for validation.
• Current criteria do not classify every patient, leading to a significant indeterminate range.

Conclusion:

Non-invasive testing may improve the identification of portal hypertension and guide further testing.

Sources:

• Portal Hypertension & Cirrhosis