Spleen stiffness measurement can predict clinical complications in compensated HCV-related cirrhosis: A prospective study

Colecchia, Antonio; Colli, Agostino; Casazza, Giovanni; Mandolesi, Daniele; Schiumerini, Ramona; Reggiani, Maria Letizia Bacchi; Marasco, Giovanni; Taddia, Martina; Lisotti, Andrea; Mazzella, Giuseppe; Biase, Anna Rita Di; Golfieri, Rita; Pinzani, Massimo; Festi, Davide

doi:10.1016/j.jhep.2014.02.024

Cited by 127 publications

(108 citation statements)

References 29 publications

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“…One important limitation of this approach is the 18% of indeterminate measurements. However, this is in line with the findings of previously published studies of CLD patients (15–20%) (Colecchia et al , , ; Fraquelli et al , ), and the most important consideration is that, even when the patients with unreliable results were included in the analysis, the results did not substantially change.…”

Section: Spleen Stiffness (Ss) and Size Values Pre‐ And Post‐treatmensupporting

confidence: 90%

“…Transient elastography (TE) (FibroScan ® ; Echosens, Paris, France) is a non‐invasive, user‐friendly quantitative means of assessing in vivo soft biological tissue stiffness, expressed in kilopascal (kPa), which is now widely used as a surrogate marker of disease severity, particularly in patients with chronic liver disease (CLD). The measurement of spleen stiffness (SS) has also recently been evaluated as an attractive alternative and/or complementary approach to measuring liver stiffness (LS) in order to assess the severity of liver disease (Colecchia et al , , ). During a previous investigation of the diagnostic accuracy of combining LS and SS in order to predict liver fibrosis and portal hypertension in patients with chronic viral hepatitis and a control population of 64 healthy volunteers and 48 patients with haematological malignancies but no significant hepatic comorbidity (Fraquelli et al , ), we not only gained insights into the use of spleen‐TE (S‐TE) in haematological patients, but our attention was also drawn to the finding of a correlation between SS and bone marrow fibrosis ( P < 0·01), which was more pronounced in patients with primary myelofibrosis (PMF) than in those with other haematological malignancies.…”

Section: Spleen Stiffness (Ss) and Size Values Pre‐ And Post‐treatmenmentioning

confidence: 99%

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Transient elastography spleen stiffness measurements in primary myelofibrosis patients: a pilot study in a single centre

et al. 2015

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Section: Spleen Stiffness (Ss) and Size Values Pre‐ And Post‐treatmensupporting

confidence: 90%

Section: Spleen Stiffness (Ss) and Size Values Pre‐ And Post‐treatmenmentioning

confidence: 99%

Transient elastography spleen stiffness measurements in primary myelofibrosis patients: a pilot study in a single centre

et al. 2015

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“…Spleen stiffness (SS) measurement by TE has been recently proposed as a novel parameter more tightly related to PH, with promising results . In fact, SS > 54 kPa was better than LS and similar to HVPG in predicting first clinical decompensation in one study.…”

Section: E Diagnosis and Monitoringmentioning

confidence: 99%

Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases

et al. 2016

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“…Accordingly, spleen stiffness measurement (SSM) may be a valuable tool for assessing the degree of PH, the presence and severity of EVs and the risk of bleeding among patients with chronic liver disease. Recent studies have shown that SSM can assess the severity of PH, the risk of variceal bleeding and the presence of (large) EVs and variceal hemorrhage among patients with cirrhosis, although it cannot predict the grade of EVs [12,14,15,[20][21][22] .…”

Section: Introductionmentioning

confidence: 99%

Spleen and Liver Stiffness Is Positively Correlated with the Risk of Esophageal Variceal Bleeding

et al. 2016

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Background/Aims: Portal hypertension (PH) is a common complication of chronic liver disease and results in esophageal and gastric variceal bleeding, which is associated with a high mortality rate. Measurement of the hepatic venous pressure gradient (HVPG) is considered the gold standard for diagnosing PH and estimating the risk of varices and bleeding. In contrast, upper gastrointestinal (GI) endoscopy (UGE) can reliably demonstrate the presence of varices and bleeding. Both measures are invasive, and HVPG is mainly restricted to tertiary centers. Therefore, the development of noninvasive methods of assessing the severity of PH and the risk of variceal bleeding is warranted. Methods: We retrospectively examined the correlation of spleen stiffness (SSM) and liver stiffness measurements (LSM) with the incidence of variceal bleeding among 143 patients who underwent combined liver and spleen elastography between 2013 and 2015. Results: For 19 of 103 patients (16.8%), upper GI variceal bleeding was diagnosed and treated endoscopically. The median SSM of all patients was 35.3 kilopascals (kPa); the median LSM, 11.7 kPa. Patients with previous bleeding episodes had significantly higher SSM (75.0 kPa) and LSM (37.3 kPa) than those without a history of bleeding (SSM, 30.6 kPa; LSM, 8.2 kPa; p < 0.0001). Seventy-five patients (66.4%) underwent UGE in addition to SSM and LSM: 25 with no esophageal varices (EVs; SSM, 29.5 kPa; LSM, 11.4 kPa), 16 with EV grade 1 (SSM, 35.9 kPa; LSM, 33.4 kPa), 21 with EV grade 2 (SSM, 67.8 kPa; LSM, 27.0 kPa) and 13 with EV grade 3 (SSM, 75.0 kPa; LSM, 26.3 kPa). No statistically significant differences were found between respective grades of EV but were found between the presence and absence of varices. At a calculated cutoff level of 42.6 kPa (with application of 95% CI), SSM had sensitivity of 89% and specificity of 64% in determining the risk of bleeding, with a negative predictive value (NPV) of 0.97 (LSM sensitivity, 84%; LSM specificity, 80%; LSM NPV, 0.96 at LSM cutoff level of 20.8 kPa). When LSM (cutoff level, 20.8 kPa) and SSM (cutoff level, 42.6 kPa) were combined, the NPV was 1 (sensitivity, 100%; specificity, 55%). Conclusion: SSM and LSM as determined by FibroScan (a noninvasive method of detecting PH) is positively correlated with upper GI variceal bleeding (optimal SSM cutoff level, 42.6 kPa; optimal LSM cutoff level, 20.8 kPa). No patients with both SSM and LSM below cutoff levels had a history of bleeding complications.

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Spleen stiffness measurement can predict clinical complications in compensated HCV-related cirrhosis: A prospective study

Cited by 127 publications

References 29 publications

Transient elastography spleen stiffness measurements in primary myelofibrosis patients: a pilot study in a single centre

Transient elastography spleen stiffness measurements in primary myelofibrosis patients: a pilot study in a single centre

Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases

Spleen and Liver Stiffness Is Positively Correlated with the Risk of Esophageal Variceal Bleeding

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