Portal hypertension laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]


There are no diagnostic laboratory findings exclusively associated with portal hypertension. Laboratory findings related with the diagnosis of cirrhosis, as the most common underlying disease for portal hypertension, include indirect serum markers and direct fibrosis markers. Indirect serum markers are platelet count, AST/ALT index, AST/platelet ratio index, and Lok score. Direct fibrosis markers are fibrotest, fibrometer, hepascore, hyaluronic acid, and enhanced liver fibrosis.

Laboratory Findings

  • There are no diagnostic laboratory findings exclusively associated with portal hypertension.
  • Laboratory findings related with the diagnosis of cirrhosis, as the most common underlying disease for portal hypertension, include indirect serum markers and direct fibrosis markers.

Indirect serum markers

Platelet count

AST/ALT index

AST/platelet ratio index

<math display="block">APRI = [(AST/ULN)/platelet count(10^{9}/L)] \times 100</math>ULN= Upper limit of normal

  • APRI ≤ 0.50 is suggestive of absence of fibrosis and APRI > 1.50 is suggestive of presence of the significant fibrosis.[7]


<math display="block">\log_{Predicting Cirrhosis}= -5.56 -0.0089 \times platelet (\times10^{3}/mm^3) + 1.26\times AST/ALT ratio + 5.27 \times INR</math>


<math display="block">FIB-4 = Age \times AST [U/L]/ \sqrt{platelet [10^9]\times ALT[U/L]}</math>

  • FIB-4 index of less than 1.6 excludes the cirrhosis, while FIB-4 more than 3.6 is diagnostic of cirrhosis.[10]


<math display="block">Forns = 7.8111 - 3.131 \times\ln (platelet) + 0.781 \times \ln (GTT)+3.467\times \ln (age) - 0.014 \times (cholesterol)</math>

Direct fibrosis markers


<math display="block">FibroTest = 4.467\times\log_{10} [A2MG(g/L)] - 1.357 \times log_{10} [HG(g/L)] + 1.017 \times log_{10}[GMT(IU/L)] + 0.0281 \times[age(years)] + 1.737 \times log_{10} [Bili( \mu mol/L)] -1.184 \times[ApoA1(g/L)] + 0.301 \times sex - 5.54 </math>Sex: (female= 0, male= 1)

  • Fibrotest score of less than 0.1 suggests very mild or absence of fibrosis and score of more than 0.6 strongly revealed moderate to severe fibrosis.[13]


<math display="block">FibroMeter = 0.4184 \times Glc [mmol/L] + 0.0701 \times AST [U/L] + 0.00008 \times ferritin [\mu g/L] - 0.0102 \times platelet [g/L] - 0.0260 \times ALT [U/L] + 0.0459 \times BW [kg] + 0.0842 \times age [years] + 11.6226 </math>

  • FibroMeter score of less than 0.36 reveals absence of significant fibrosis, and score of more than 0.36 is suggestive of dramatic fibrosis.[13]


<math display="block">Logistic regression = y = \exp [-4.185818-(0.0249 \times age) + (0.7464 \times sex) + (1.0039\times A2MG) + (0.032 \times hyaluronic acid) + (0.0691 \times bilirubin) -(0.0012 \times GGT)]</math>

<math display="block">HepaScore= \tfrac{y}{y+1} </math>

Hyaluronic acid

Enhanced liver fibrosis

<math display="block">ELF score = 2.494+ 0.846 \times \ln (HA) + 0.735 \times \ln (PIIINP) + 0.391\times\ln (TIMP-1) </math>

  • The reference point for ELF score is 6.72 and the variable of 'age' found to be the most effective factor on the score.[16]


  1. Berzigotti A, Seijo S, Arena U, Abraldes JG, Vizzutti F, García-Pagán JC, Pinzani M, Bosch J (2013). "Elastography, spleen size, and platelet count identify portal hypertension in patients with compensated cirrhosis". Gastroenterology. 144 (1): 102–111.e1. doi:10.1053/j.gastro.2012.10.001. PMID 23058320.
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  6. Williams AL, Hoofnagle JH (1988). "Ratio of serum aspartate to alanine aminotransferase in chronic hepatitis. Relationship to cirrhosis". Gastroenterology. 95 (3): 734–9. PMID 3135226.
  7. Wai CT, Greenson JK, Fontana RJ, Kalbfleisch JD, Marrero JA, Conjeevaram HS, Lok AS (2003). "A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C". Hepatology. 38 (2): 518–26. doi:10.1053/jhep.2003.50346. PMID 12883497.
  8. Lok AS, Ghany MG, Goodman ZD, Wright EC, Everson GT, Sterling RK, Everhart JE, Lindsay KL, Bonkovsky HL, Di Bisceglie AM, Lee WM, Morgan TR, Dienstag JL, Morishima C (2005). "Predicting cirrhosis in patients with hepatitis C based on standard laboratory tests: results of the HALT-C cohort". Hepatology. 42 (2): 282–92. doi:10.1002/hep.20772. PMID 15986415.
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  10. Kim, Beom Kyung; Kim, Do Young; Park, Jun Yong; Ahn, Sang Hoon; Chon, Chae Yoon; Kim, Ja Kyung; Paik, Yong Han; Lee, Kwan Sik; Park, Young Nyun; Han, Kwang Hyub (2010). "Validation of FIB-4 and comparison with other simple noninvasive indices for predicting liver fibrosis and cirrhosis in hepatitis B virus-infected patients". Liver International. 30 (4): 546–553. doi:10.1111/j.1478-3231.2009.02192.x. ISSN 1478-3223.
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  16. Lichtinghagen, Ralf; Pietsch, Daniel; Bantel, Heike; Manns, Michael P.; Brand, Korbinian; Bahr, Matthias J. (2013). "The Enhanced Liver Fibrosis (ELF) score: Normal values, influence factors and proposed cut-off values". Journal of Hepatology. 59 (2): 236–242. doi:10.1016/j.jhep.2013.03.016. ISSN 0168-8278.

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