Blood labs & PH

[ToughToes]

Hi Everyone,

Does anybody know which blood tests, as in lliver enzymes and LFT's, might reflect portal hypertension and/or liver congestion?

Thanks in advance,

Terry

[ToughToes]

Anyone at all?

[nash2 Partner]

blood tests don't measure portal hypertension except indirectly I guess. If you have cirrhosis and consistently high liver enzymes, the probability is that you have increased portal pressure. Ultrasound can measure blood flow direction and volumes which can infer changes in portal pressure.

[ToughToes in reply to nash2]

Thanks for the info. Turns out I don't have cirrhosis based on my fibroscan results Tuesday. No scarring, but a tad more fat in my liver than I thought based on all the ultrasounds I've had in which the radiology report always said "mild fatty liver". Turns out based on the CAP score of 268,I'm just a little over(260) the cut-off between midland moderate. Bloods (LFT's/enzymes) are all great. So, it's a bit of mixed emotions ony part. Thrilled that my liver has no scarring,but a bit bummed that I have a bit more fat than I thought I did. In your opinion, would you say that the lack ofany scarring is the more important of the two?

[nash2 Partner in reply to ToughToes]

Yes, scarring or NASH is the destruction of liver cells and is the process that leads to cirrhosis and end stage liver disease. Fibrosis, not fat, correlates with mortality but excess fat is toxic and can lead eventually to NASH so reducing it is important

[ToughToes in reply to nash2]

Of course. I intend on eating better and exercising more, which, jn turn, will lead to weight loss & a decrease in fat in the liver. But, a CAP 268 isn't that bad. Just a bit over mild cutoff.

[ToughToes in reply to nash2]

Of course. I intend on eating better and exercising more, which, jn turn, will lead to weight loss & a decrease in fat in the liver. But, a CAP 268 isn't that bad. Just a bit over mild cutoff.

[ToughToes in reply to ToughToes]

My ultrasound from mid-August said grade 1 steatosis (mild fatty liver). I refuse to accept that the amount of fat in my liver went from S1 to S2 in just a month when I didn't touch alcohol during that month, nor change my diet. There's obviously a difference between the techniques used to grade the fat level between ultrasound and fibroscan.

[nash2 Partner in reply to ToughToes]

That is certainly manageable, but don't let that mild confuse you. This is what it means.

FibroScan CAP (Controlled Attenuation Parameter) scores are used to measure liver steatosis (fatty liver disease). The CAP score is a numerical value that ranges from 100 to 400 decibels per meter (dB/m).

According to the manufacturer's guidelines, a CAP score of 268 dB/m corresponds to a liver fat percentage of approximately 67% to 73%. This is based on the following CAP score ranges and corresponding liver fat percentages:

* 100-237 dB/m: < 5% liver fat

* 238-260 dB/m: 5-33% liver fat

* 261-290 dB/m: 34-66% liver fat

* 291-310 dB/m: 67-90% liver fat

* 311-400 dB/m: > 90% liver fat

Keep in mind that these ranges are approximate and may vary depending on the individual patient and the specific FibroScan device used. It's also important to note that CAP scores should be interpreted in conjunction with other clinical and laboratory findings to accurately diagnose and monitor liver disease.

In this case, a CAP score of 268 dB/m suggests that approximately 67% to 73% of the liver is composed of fat, which is a significant amount of liver steatosis. However, it's essential to consult with a healthcare professional to determine the clinical significance of this finding and develop an appropriate treatment plan.

[ToughToes in reply to nash2]

How can 268 be 67% when 261-290 is only 34%-66%? 268 is 22 lower than 290 and 290 is 66%.

[ToughToes in reply to nash2]

268 is a lot closer to 261 which is 34% than to 290 which is 66%. So, 268 us likely around 40%, not 67%.

[nash2 Partner in reply to ToughToes]

It just shows that that particular measure is very imprecise. In any case, it suggests that there is significant fat in the cells. If you want an accurate measure, get your doc to order a PDFF (protein density fat fraction), that is an MRI based test that is quite accurate. The exact value of CAP isn't really important but it does indicate that dealing with it is the prudent course which I believe you are doing.

[ToughToes in reply to nash2]

Dude, just admit your math was way off! You say my CAP of 268 equals 67-73%. That's impossible when a CAP of 290 equals 66%. Can you see your error in calculation? If a CAP of 260 equals 34% liver fat and a CAP if 290 equals 66% liver fat, a CAP of 268 would be in the 42-45% range, far lower than your estimate of 67-73%.

[nash2 Partner in reply to ToughToes]

Not my math, those are the scales Fibroscan publishes. It just shows the squishyness of the test. These aren't linear relationships and the error bars are wide. I just object to their use of the term "mild" because people don't understand that it really indicates a significant amount of fat regardless of what they want to call the percentage.

[ToughToes in reply to nash2]

It is your math. Re-read what you wrote. If a CAP score of 290 represents 66% fat in liver, how can a substabtially lower CAP score odlf 268 equal a higher fat percentage of 67-73%? A CAP of 268 would, logically, be in the neighborhood of 42-45% fat in the liver. Follow me now? By the way, where did you read that a CAP of 268 equals between 67-73%?

[nash2 Partner in reply to ToughToes]

No, I didn't do the math, it is published literature. To argue the case you have to take it up with the researchers. I'm just explaining the problem. Your argument isn't with me.

[ToughToes in reply to nash2]

can you please provide the link?

[nash2 Partner in reply to ToughToes]

A FibroScan is a non-invasive device that uses transient elastography to assess liver stiffness and steatosis (fat accumulation) through two measurements: **liver stiffness measurement (LSM)** and **controlled attenuation parameter (CAP)**. The CAP score, measured in decibels per meter (dB/m), specifically quantifies the degree of hepatic steatosis. Higher CAP scores indicate greater fat accumulation in the liver.

The grading of liver steatosis is often aligned with histological classifications based on the percentage of hepatocytes containing fat:

- **S0**: <5% hepatocytes with fat (no steatosis)

- **S1**: 5–33% hepatocytes with fat (mild steatosis)

- **S2**: 34–66% hepatocytes with fat (moderate steatosis)

- **S3**: >66% hepatocytes with fat (severe steatosis)

**For a CAP score of 268 dB/m**, this value corresponds to **moderate steatosis (grade S2)**, which means approximately **34% to 66% of the liver cells (hepatocytes) contain fat**.

This correlation is supported by clinical studies that have established CAP score thresholds corresponding to different grades of steatosis. One notable study is the individual patient data meta-analysis by Karlas et al. (2017), which determined optimal CAP cut-off values for diagnosing steatosis grades:

- **S≥1 (≥5% fat)**: CAP ≥248 dB/m

- **S≥2 (≥34% fat)**: CAP ≥268 dB/m

- **S≥3 (≥66% fat)**: CAP ≥280 dB/m

**References:**

1. **Karlas T, Petroff D, Sasso M, et al.** Individual patient data meta-analysis of controlled attenuation parameter (CAP) technology for assessing steatosis. *Journal of Hepatology*. 2017;66(5):1022-1030. [Link to the study](journal-of-hepatology.eu/ar...

2. **Sasso M, Beaugrand M, de Ledinghen V, et al.** Controlled Attenuation Parameter (CAP): A Novel Vibration-Controlled Transient Elastography Quantification of Steatosis. *Ultrasound in Medicine & Biology*. 2010;36(11):1825-1835. [Link to the study](sciencedirect.com/science/a...

A CAP score of **268 dB/m indicates moderate liver steatosis**, correlating with **34% to 66% of liver cells containing fat**. This assessment helps clinicians determine the extent of liver fat accumulation and guide appropriate management for conditions like non-alcoholic fatty liver disease (NAFLD).

[ToughToes in reply to nash2]

I've been going by a grading scale from Skoan-Kettering hospital, which had S1 (mild steatosis) based on CAP scorescorscores ranging between 230 and 260; S2 (moderate steatosis) ranging between 261 and 290; and S3 (severe steatosis) with CAP scores ranging from 290 aand 400. The corresponding fat percentages are S1 - 11% to 33%; S2 - 34% to 66%; and S3 - 67% to 100%. That is why, if a CAP of 261 us equal to 34% fat, based on the numbers, a CAP of 268 would be roughly 42% to 45%. Understand?

[nash2 Partner in reply to ToughToes]

Big institutions like that may do their own research and present data in a form they like. My objection with all of them is they always say mild/moderate without giving patients any real understanding of how much fat that actually means. A lot of patients think that they are OK and there is no need to really do anything which is not healthy in the long run.

[ToughToes]

Meant cut-off between mild and moderate.

[ToughToes]

If a CAP of 290 is only 67% liver fat, then it's impossible that a CAP of 268 would equal 67-73% fat percentage. A CAP of 268, given that a CAP if 260 equals 34% fat and a CAP of 290 equals 66% fat, would fall between 42-45%.