Spleen stiffness measurement for assessing the response to β-blockers therapy for high-risk esophageal varices patients

Marasco, Giovanni; Dajti, Elton; Ravaioli, Federico; Alemanni, Luigina Vanessa; Capuano, Fabiana; Gjini, Kamela; Colecchia, Luigi; Puppini, Giovanni; Cusumano, Caterina; Renzulli, Matteo; Golfieri, Rita; Festi, Davide; Colecchia, Antonio

doi:10.1007/s12072-020-10062-w

Cited by 46 publications

(47 citation statements)

References 23 publications

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“…We did not exclude patients taking pharmacological treatment for PH from the original protocol as it was suspected that non-selective beta blockers and banding of varices would be unlikely to affect splenic measurements[ 32 ]. However, the most recent data on cirrhotic patients with high risk varices suggests that taking non-selective beta blockers can affect splenic stiffness[ 33 , 34 ]. Nevertheless these studies were undertaken using Fibroscan ® and VTQ (Siemens Acuson S2000TM) ultrasound systems and so, further information is still needed in order to confirm that similar findings are present with the ElastPQ.…”

Section: Discussionmentioning

confidence: 99%

Non-invasive splenic parameters of portal hypertension: Assessment and utility

Ahmad¹,

Atzori²,

Maurice³

et al. 2020

WJH

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BACKGROUND Portal hypertension is a major complication of cirrhosis that is associated with significant morbidity and mortality. The present gold-standard method to risk stratify and observe cirrhosis patients with portal hypertension is hepatic venous pressure gradient measurement or esophagogastroduodenoscopy. However, these methods are invasive, carry a risk of complications and are associated with significant patient discomfort. Therefore, non-invasive splenic parameters are of clinical interest as potential useful markers in determining the presence of portal hypertension. However, diagnostic accuracy and reproducibility remains unvalidated. AIM To assess the diagnostic accuracy of spleen stiffness, area and diameter in predicting the presence of portal hypertension. METHODS Of 50 patients with varying liver disease pathologies were prospectively recruited from the St. Mary’s Hospital Liver Unit in London; 25 with evidence of portal hypertension and 25 with no evidence of portal hypertension. Liver stiffness, spleen stiffness, spleen diameter and spleen area were measured using the Philips Affiniti 70 elastography point quantification point shear wave elastography system. The aspartate aminotransferase-to-platelet-ratio-index (APRI) score was also calculated. Performance measures, univariate and multivariate logistic regression were used to evaluate demographic, clinical and elastography variables. Interclass correlation coefficient was used to determine the reproducibility of splenic area and diameter. RESULTS On univariate and individual performance, platelet count [area under the receiver operating characteristic (AUROC) 0.846, P value < 0.001], spleen area (AUROC 0.828, P value = 0.002) and APRI score (AUROC 0.827, P value < 0.001) were the most accurate variables in identifying the presence of portal hypertension. On multivariate logistic regression models constructed, the combination of spleen area greater than 57.90 cm 2 and platelet count less than 126 × 10 9 had 63.2% sensitivity and 100% specificity, 100% positive predictive value and 100% negative predictive value. An alternative combination of spleen stiffness greater than 29.99 kPa and platelet count less than 126 × 10 9 had 88% sensitivity, 75% specificity, 78.6% positive predictive value and 85.7% negative predictive value. An interclass correlation coefficient value of 0.98 (95%CI: 0.94-0.99, P value < 0.001) and 0.96 (95%CI: 0.91-0.99, P value < 0.001) were determined for inter-operator variability for spleen area and diameter respectively. CONCLUSION Spleen area, spleen stiffness and platelet count may be useful markers to assess the presence of portal hypertension in patients of various etiologies...

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Section: Discussionmentioning

confidence: 99%

Non-invasive splenic parameters of portal hypertension: Assessment and utility

Ahmad¹,

Atzori²,

Maurice³

et al. 2020

WJH

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“…However, none of these studies has included portal hypertension-related variables, even though portal hypertension plays a significant role in liver carcinogenesis. 8,9 In a recent paper by our study group, 10 we found that spleen stiffness measurement (SSM), a direct noninvasive surrogate of portal hypertension, 11,12 was the only independent predictor of late HCC recurrence after hepatic resection in cirrhotic patients.…”

Section: Introductionmentioning

confidence: 94%

Risk of hepatocellular carcinoma after HCV eradication: Determining the role of portal hypertension by measuring spleen stiffness

et al. 2021

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LSM-SVR24 ≤10 kPa HCC surveillance MODERATE LSM-SVR24 10-20 kPa and SSM-SVR24 ≤42 kPa HIGH LSM-SVR24 >20 kPa or SSM-SVR24 >42 kPa No surveillance, US yearly US-based surveillance every 6 months (±AFP) Closer follow-up by US alternated to CT/(a)MRI Non-invasive assessment HCC risk LSM SSM Highlights Portal hypertension plays an important role in liver carcinogenesis after DAA treatment.SSM is an independent predictor of HCC development after viral eradication, with a best cut-off of 42 kPa.An algorithm based on LSM and SSM at SVR24 can be used to stratify for the risk of HCC and to guide surveillance. Lay summarySpleen stiffness predicts the development of hepatocellular carcinoma after viral eradication, especially in patients with post-treatment liver stiffness values >10 kPa. An algorithm based on liver and spleen stiffness can stratify for the risk of liver cancer development and guide the surveillance strategies after treatment with direct-acting antivirals.

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“…However, spleen stiffness measurement seems to be a suitable non-invasive tool for evaluation of response to NSBB. Two recent studies using pSWE [53]and VCTE [54] technique indicate promising results in noninvasive NSBB response evaluation but further data and standardization is needed in this field. Absence of spleen stiffness measurement could be considered a weak point of our study; nonetheless, based on the above-mentioned data, we could have not expected a breaking improvement of HVPG prediction using also spleen stiffness measurement.…”

Section: Plos Onementioning

confidence: 99%

Liver stiffness measured by two-dimensional shear-wave elastography predicts hepatic vein pressure gradient at high values in liver transplant candidates with advanced liver cirrhosis

et al. 2021

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Liver stiffness is a reliable non-invasive predictor of Hepatic Venous Pressure Gradient (HVPG) above 10 mm Hg. However, it failed to predict higher thresholds of HVPG. Our aim was to investigate whether liver stiffness and selected previously published non-invasive blood biomarkers could predict higher HVPG thresholds in liver transplant candidates without ongoing alcohol use. One hundred and nine liver transplant candidates with liver cirrhosis of various aetiologies underwent direct HVPG measurement, liver stiffness measurement by 2D shear-wave elastography (Aixplorer Multiwave, Supersonic Imagine, France) and assessment of blood HVPG biomarkers (osteopontin, VCAM-1, IL-6, TNF-α, IL-1ra/IL-1F3 and ELF score). The correlation between liver stiffness and HVPG was linear up to 30 mm Hg of HVPG (r = 0.765, p < 0.0001). The regression lines had similar slopes for HVPG values below and above 16 mm Hg (p > 0.05) and the correlation in patients with HVPG <16 mm Hg (r = 0.456, p = 0.01) was similar to patients with HVPG ≥ 16 mm Hg (r = 0.499, p < 0.0001). The correlation was similar in the subgroup patients with alcoholic (r = 0.718, p < 0.0001), NASH (r = 0.740, p = 0.008), cryptogenic (r = 0.648, p = 0,0377), cholestatic and autoimmune (r = 0.706, p < 0.0001) and viral cirrhosis (r = 0.756, p < 0.0001). Liver stiffness distinguished patients with HVPG above 16, and 20 mm Hg with AUROCs 0.90243, and 0.86824, sensitivity 0.7656, and 0.7027, and specificity 0.9333, and 0.8750. All studied blood biomarkers correlated better with liver stiffness than with HVPG and their AUROCs did not exceed 0.8 at both HVPG thresholds. Therefore, a composite predictor superior to liver stiffness could not be established. We conclude that liver stiffness is a clinically reliable predictor of higher HVPG thresholds in non-drinking subjects with advanced liver cirrhosis.

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Spleen stiffness measurement for assessing the response to β-blockers therapy for high-risk esophageal varices patients

Cited by 46 publications

References 23 publications

Non-invasive splenic parameters of portal hypertension: Assessment and utility

Non-invasive splenic parameters of portal hypertension: Assessment and utility

Risk of hepatocellular carcinoma after HCV eradication: Determining the role of portal hypertension by measuring spleen stiffness

Liver stiffness measured by two-dimensional shear-wave elastography predicts hepatic vein pressure gradient at high values in liver transplant candidates with advanced liver cirrhosis

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