Clin Infect Dis. 2013 Nov 21. [Epub ahead of print]
Unidad de Enfermedades Infecciosas/VIH, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Background. Hepatic venous pressure gradient (HVPG) is the best indicator of prognosis in patients with compensated cirrhosis. We compared HVPG and transient elastography (TE) for the prediction of liver-related events (LRE) in patients with HCV-related cirrhosis with or without HIV coinfection. Methods. Retrospective review of all consecutive patients with compensated HCV-related cirrhosis who were assessed simultaneously using TE and HVPG between January 2005 and December 2011. We used receiver operating characteristic (ROC) curves to determine the ability of TE and HVPG to predict the first LRE (liver decompensation or hepatocellular carcinoma). Results. The study included 60 patients, 36 of whom were coinfected with HIV. After a median follow-up of 42 months, 6 patients died, 8 experienced liver decompensations, and 7 were diagnosed with hepatocellular carcinoma. The area under the ROC curve (AUROC) (95% confidence interval) of TE and HVPG for prediction of LRE in all patients was 0.85 (0.73-0.97) and 0.76 (0.63-0.89) (P=0.13); for HIV-infected patients, the AUROC was 0.85 (0.67-1.00) and 0.81 (0.64-0.97), (P=0.57); and for non-HIV-infected patients the AUROC was 0.88 (0.75-1.00) and 0.77 (0.57-0.97) (P=0.19). Based on the AUROC values, 2 TE cutoff points were chosen to predict the absence (< 25 kPa) or presence (≥ 40 kPa) of LRE, thus enabling correct classification of 82% of patients. Conclusions. Our data suggest that TE is at least as valid as HVPG for predicting LRE in patients with compensated HCV-related cirrhosis coinfected or not with HIV.
PMID: 24265358 [PubMed - as supplied by publisher]