Indocyanine green as a predictor of clinically significant portal hypertension in a prospective cohort study of patients with chronic liver disease.

none12noIntroduction: Measurement of hepatic venous pressure gradient (HVPG) is the gold standard for the assessment of portal hypertension (PH) and the prediction of clinical decompensation in patients with cirrhosis and PH. The development of non-invasive methodologies able to identify clinically significant PH and predict disease progression is needed. Indocyanine green clearance at 15 minutes (IcgR15) is an index of liver blood flow, functioning hepatocyte mass and energy status of the liver. In this ongoing study, we evaluate the ability of IcgR15 and other non-invasive tests to predict PH in patients with chronic liver disease of various etiology. Methods: Sixty-seven consecutive patients (43M/34F, mean age 61.09±12.57; age range 33 - 84 years) with chronic liver disease underwent HVPG measurement in our radiological unit between January and November 2010. All patients underwent laboratory tests, EGDS, abdominal ultrasound and IcgR15. Mann-Whitney test and multiple regression analysis has been performed in order to identify variables independently associated with HVPG>10mmHg, HVPG>12 and gastro-esophageal varices (GEV). ROC curves were used to define the best cut-off (Medcalc software v11.4). Results: Platelets count (P10 and HVPG>12 while bilirubin, albumin, INR, MELD, spleen diameter, APRI were not. On multiple regression both platelets count and IcgR15 were significantly related to HVPG>10 (respectively P=0.0004 and 0.02, r= -0.54 and r= 0.45) and HVPG>12 (respectively P=0.007 and P9.7% (sensitivity 83.0%, specificity 65.0%, AUROC 0.81, P10mmHg and PLT≤123.000 (sensitivity 76.3%, specificity 75.9%, AUROC 0.81, P12.4% (sensitivity 84.2%, specificity 72.4%, AUROC 0.87, P12mmHg. ROC curve identified IcgR15>10.5% as the best predictor of GEV presence (sensitivity 87.2%, specificity 67.9%, AUROC 0.80, P