From the Guidelines
Liver function tests, including serum albumin, bilirubin, prothrombin time/INR, AST, ALT, alkaline phosphatase, and gamma-glutamyl transferase, are essential for evaluating portal hypertension, as they help assess liver synthetic function and identify the severity of liver damage contributing to portal hypertension. These tests, along with complete blood count to detect thrombocytopenia (platelet count <150,000/μL) and imaging studies like ultrasound with Doppler, CT, or MRI, collectively help determine the underlying cause of portal hypertension, assess disease severity, guide treatment decisions, and monitor disease progression or treatment response 1.
Key Tests for Portal Hypertension
- Serum albumin: decreased levels (normal: 3.5-5.0 g/dL) indicate impaired liver synthetic function
- Bilirubin: elevated levels (normal: <1.2 mg/dL) suggest compromised bile excretion
- Prothrombin time/INR: prolonged prothrombin time indicates impaired liver synthetic function
- AST/ALT: moderately elevated in chronic liver disease causing portal hypertension, though they don't directly correlate with portal pressure
- Complete blood count: to detect thrombocytopenia (platelet count <150,000/μL), which often indicates portal hypertension due to splenic sequestration
- Imaging studies: ultrasound with Doppler, CT, or MRI to visualize portal vein flow and identify collateral vessels
Importance of Recent Guidelines
The most recent study 1 highlights the importance of noninvasive liver disease assessment to identify portal hypertension, supporting the AASLD practice guideline. This study emphasizes the limitations of liver stiffness measurement (LSM) in assessing severe portal hypertension and the need for a comprehensive approach to evaluating portal hypertension.
Clinical Implications
In clinical practice, it is crucial to prioritize the most recent and highest quality study, which in this case is 1, to guide the evaluation and management of portal hypertension. By following the recommendations outlined in this study, clinicians can improve patient outcomes and reduce morbidity and mortality associated with portal hypertension.
From the Research
Liver Function Test on Portal Hypertension
- Portal hypertension is a common complication of chronic liver diseases and is responsible for most clinical consequences of cirrhosis 2.
- The condition can be managed using various treatments, including non-selective beta-blockers, statins, or antibiotics, which reduce portal hypertension by decreasing intrahepatic resistance or portal tributary blood flow 3.
- Liver function tests, such as galactose eliminating capacity, can be used to evaluate the effectiveness of treatments on hepatic function 4.
- Studies have shown that the combination of beta-blockers and nitrates can be effective in reducing portal pressure without adverse effects on hepatic perfusion and liver function 5, 6.
- The use of non-invasive techniques, such as hepatic vein catheterization and indocyanine green constant infusion, can provide valuable information on liver blood flow and liver metabolic activity in patients with cirrhosis and portal hypertension 6.
- The treatment of portal hypertension should be guided by the interruption of initiating factors, and combined approaches should be considered before liver transplantation 3.
- Systemic drugs, such as non-selective beta-blockers, can reduce portal hypertension by decreasing intrahepatic resistance or portal tributary blood flow 4.
- Shunts, mostly as intrahepatic stent bypass between portal and hepatic vein branches, have played an important role in the prevention of recurrent bleeding and ascites formation 3.