From Routine Doppler to Critical Decisions: Portal Pressure

Background: Direct measurement of portal pressure using hepatic venous pressure gradient (HVPG) remains the reference standard for assessment of portal hypertension but is invasive, resource-intensive, and unavailable in many centers. In such settings, ultrasonography (USG) continues to be the primary imaging modality used for clinical decision-making. Objective: To develop a physiology-driven, Doppler ultrasound?derived mathematical model for estimating portal pressure (PPe) and to perform a pilot validation by assessing agreement between model-derived pressure categories and clinically determined severity of portal hypertension. Materials and Methods: In this cross-sectional observational study, 50 patients with suspected chronic liver disease underwent standardized Doppler ultrasound evaluation. Hemodynamic parameters representing portal flow, splenic contribution, intrahepatic resistance, and flow reversal were incorporated into a composite mathematical model derived using multivariate linear regression. The resulting portal pressure estimate (PPe) was categorized into clinically relevant severity groups and compared with clinically assigned portal hypertension stages using Cohen?s kappa statistic. Results: The Doppler-derived model demonstrated moderate to substantial agreement with clinical severity classification (? = 0.605; 95% CI: 0.43-0.78). The model effectively stratified patients into low-, intermediate-, and high-risk portal hypertension categories corresponding to recognized clinical thresholds. Conclusion: This pilot study demonstrates the feasibility of a non-invasive, ultrasound-based hemodynamic model for portal pressure estimation. While not a substitute for invasive measurement, the model provides a physiologically coherent framework for quantitative risk stratification in settings where HVPG is unavailable. Further large-scale validation with simultaneous invasive measurements is warranted.