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.
