Fuentes de variabilidad de la elastografía transitoria hepática y mejoría de su capacidad predicitiva para el diagnóstico de hipertensión portal clínicamente significativa en pacientes con cirrosis compensada

Abstract

The most common and severe complication of liver cirrhosis is portal hypertension, which represents the most relevant factor regarding prognosis. Portal hypertension syndrome is defined as an increase in portal pressure gradient above the normal range (1-5 mmHg). In order to develop, esophageal varices, ascites, bleeding, encephalopathy and all other complications associated with this syndrome require a portal pressure gradient above 10 mmHg. The term clinically significant portal hypertension (CSPH) has been coined to define this condition, which is always present in patients with decompensated liver disease. Approximately 50% to 70% of patients with compensated disease have CSPH, which in turn is an independent predictive factor for clinical decompensation. Similarly, esophageal varices are present at the time of cirrhosis diagnosis in 40% of compensated patients and 60% of patients with ascites. The gold standard in assessing portal pressure is the measurement of hepatic venous pressure gradient (HVPG), which is the difference between the wedged (WHVP) and the free hepatic venous pressures (FHVP). This measurement is performed by catheterization of the suprahepatic veins. While this is the most accurate and reliable method currently available, it is an invasive technique requiring specialized materials and personal not available in all health care centers. Therefore, it cannot be routinely used in all units caring for patients with liver diseases...