Noninvasive Markers of Portal Hypertension and Varices in Noncirrhotic Disease

Noncirrhotic portal hypertension (NCPH) encompasses a range of disorders affecting the hepatic portosinusoidal vascular system, leading to portal hypertension (PH). Unlike cirrhosis, there are no established noninvasive criteria to diagnose PH or varices in NCPH. A study aimed to address this gap by evaluating noninvasive markers, including liver stiffness measurement (LSM) via transient elastography, platelet count, and imaging/laboratory data, to predict PH and varices.

The study included patients with NCPH who underwent transjugular liver biopsy. PH was defined by the presence of varices on endoscopy, portosystemic collaterals, or ascites on imaging. Results indicated that LSM values were higher in patients with PH and varices, while platelet counts were significantly lower in these groups. A multivariate analysis combining LSM and platelet count demonstrated strong predictive ability for PH and varices, with high sensitivity, negative predictive value, and accuracy.

A stepwise decision model incorporating platelet count and LSM was developed to noninvasively detect PH and varices. The model showed 100% sensitivity and negative predictive value for both PH and varices, with high overall accuracy. This suggests that combining LSM and platelet count could serve as a reliable, noninvasive method to identify NCPH patients at risk for PH and varices. However, further validation in independent cohorts is necessary to confirm its utility.

In conclusion, this study highlights the potential of noninvasive markers as effective tools for diagnosing PH and varices in NCPH, reducing the need for invasive procedures like liver biopsy.