REVIEW   

Minerva Medica 2020 June;111(3):266-80

DOI: 10.23736/S0026-4806.19.06143-3

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Diagnostic accuracy of non-invasive methods detecting clinically significant portal hypertension in liver cirrhosis: a systematic review and meta-analysis

Ramesh RANA ^{1, 2}, Shenglan WANG ¹, Jing LI ¹, Shiva BASNET ³, Liang ZHENG ⁴, Changqing YANG ¹ ✉

¹ Division of Gastroenterology and Hepatology, Digestive Disease Institute, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China; ² Department of Internal Medicine, Gautam Buddha Community Heart Hospital, Butwal, Nepal; ³ Department of Gastrointestinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China; ⁴ Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China

INTRODUCTION: We attempted to investigate non-invasive techniques and their diagnostic performances for evaluating clinically significant portal hypertension.
EVIDENCE ACQUISITION: The systematic search was performed on PubMed, Embase, Scopus, and Web of Science TM core index databases before 13 December 2018 restricted to English language and human studies.
EVIDENCE SYNTHESIS: Thirty-two studies were included, with total populations of 3,987. The overall pooled analysis was performed by bivariate random effect model, which revealed significantly higher sensitivity and specificity of 77.1% (95% confidence interval, 76.8-78.5%) and 80.1% (95% confidence interval, 78.2-81.9%), respectively; positive likelihood ratio (3.67), negative likelihood ratio (0.26); and diagnostic odd ratio (16.24). Additionally, the area under curve exhibited significant diagnostic accuracy of 0.871. However, notable heterogeneity existed in between studies (I2=87.1%), therefore, further subgroup analysis was performed. It demonstrated ultrasonography, elastography, biomarker, and computed tomography scan had a significant overall summary sensitivity (specificity) of 89.6% (78.9%), 81.7% (83.2%), 72.2% (76.8%), and 77.2% (81.2%), respectively. Moreover, the areas under curve values were significantly higher in elastography (0.906), followed by computed tomography scan (0.847), biomarker (0.825), and ultrasonography (0.803).
CONCLUSIONS: In future, non-invasive techniques could be the future choice of investigations for screening and diagnosis of clinically significant portal hypertension in cirrhosis. However, standardization of diagnostic indices and their cut-off values in each non-invasive method needs to be addressed.

KEY WORDS: Hypertension, portal; Venous pressure; Liver cirrhosis; Ultrasonography; Elasticity imaging techniques; Biomarkers