Reliability of Transient Elastography-Based Liver Stiffness for Diagnosing Portal Hypertension in Patients with Alcoholic Liver Disease: A Diagnostic Meta-Analysis with Specific Cut-Off Values

Background Transient elastography-based liver stiffness value (TE-LSV) has been studied for the diagnosis of portal hypertension. Liver stiffness is influenced by the disease etiology. We aimed to perform a meta-analysis to determine the per-formance of TE-LSV for diagnosing portal hypertension in patients with alcoholic liver disease (ALD).Methods We searched PubMed, Web of Science, Ovid and Cochrane library. A bivariate model was used to compute sensitivity and specificity. A random effects model was used to pool diagnostic odds ratios.Results 9 studies with 679 patients were included. The pooled sensitivity and specificity based on a cut-off value around 21.8 kPa for clinically significant portal hypertension (CSPH) were 0.89 (95 % confidence interval (CI), 0.83-0.93) and 0.71(95 % CI, 0.64-0.78), respectively. For severe portal hypertension (SPH), the pooled sensitivity and specificity for a cut-off value around 29.1 kPa were 0.88 (95 % CI, 0.83-0.92) and 0.74 (95 % CI, 0.67-0.81), respectively.Conclusion TE-LSV showed good performance for diagnosing portal hypertension in patients with ALD. The optimal cut-off value for CSPH and SPH was around 21.8 kPa and 29.1 kPa, respectively, and these two cut-off values showed good sensitivity and modest specificity. The etiology should be clear before using TE-LSV for portal hypertension.

背景 基于瞬时弹性成像的肝脏硬度值（TE - LSV）已被用于门静脉高压的诊断研究。肝脏硬度受疾病病因影响。我们旨在进行一项荟萃分析，以确定TE - LSV在酒精性肝病（ALD）患者中诊断门静脉高压的效能。 方法 我们检索了PubMed、Web of Science、Ovid和Cochrane图书馆。采用双变量模型计算敏感度和特异度。使用随机效应模型合并诊断比值比。 结果 纳入了9项研究，共679例患者。对于临床显著门静脉高压（CSPH），以约21.8 kPa为临界值，合并敏感度和特异度分别为0.89（95%置信区间（CI），0.83 - 0.93）和0.71（95% CI，0.64 - 0.78）。对于重度门静脉高压（SPH），以约29.1 kPa为临界值，合并敏感度和特异度分别为0.88（95% CI，0.83 - 0.92）和0.74（95% CI，0.67 - 0.81）。 结论 TE - LSV在诊断ALD患者的门静脉高压方面表现良好。CSPH和SPH的最佳临界值分别约为21.8 kPa和29.1 kPa，这两个临界值显示出良好的敏感度和适度的特异度。在使用TE - LSV诊断门静脉高压之前应明确病因。