TOPLINE:
Spleen stiffness measurement (SSM) demonstrated strong predictive accuracy for liver decompensation in patients with compensated advanced chronic liver disease (cACLD), with an optimal cutoff of 50 kPa.
METHODOLOGY:
- Portal hypertension is a key prognostic factor in cACLD. Although hepatic venous pressure gradient measurement is the gold standard for assessing it, noninvasive approaches like liver stiffness measurement (LSM) and SSM have gained importance.
- Researchers conducted a prospective study to examine the relationship between the presence of portal hypertension via SSM and liver decompensation risk in patients with cACLD.
- Participants underwent vibration-controlled transient elastography of the liver and spleen, with a 100-Hz module used to measure spleen stiffness.
- Diagnosis of cACLD was based on an LSM value of > 12.5 kPa or histologic evidence. Liver decompensation was defined as the occurrence of ascites, variceal bleeding, hepatic encephalopathy, or jaundice.
- The primary outcome was the occurrence of liver decompensation. Receiver operating characteristic curves and Youden’s index were used to determine optimal cutoff values for LSM and SSM.
TAKEAWAY:
- Researchers included 242 patients with cACLD (mean age, 63 years; 21% women), most of whom (62%) had alcoholic liver disease.
- During a median follow-up period of 501.5 days, 28 patients developed liver decompensation, with 32 hospitalization events reported among 20 individuals.
- LSM had a modest predictive performance (area under the curve [AUC] = 0.715) for liver decompensation, with an optimal cutoff of 21.6 kPa (sensitivity, 82.1%; specificity, 53.3%).
- SSM performed better (AUC = 0.823), with an optimal cutoff of 50.3 kPa (sensitivity, 82.1%; specificity, 72.9%).
- Patients with both LSM > 25 kPa and SSM > 50 kPa had the highest risk for decompensation. Among patients already classified as high risk based on LSM > 25 kPa, those with SSM > 50 kPa had a higher risk for decompensation than those with SSM < 50 kPa.
- Each one-unit increase in SSM was associated with a 4% increased risk for hepatic decompensation over a 32-month period (P < .001).
IN PRACTICE:
“Noninvasive evaluation with SSM appears to be a promising tool for predicting the risk of liver-related complications. This could help to improve the management and outcomes of patients with cACLD,” authors of the study wrote.
SOURCE:
This study was led by Rui Gaspar, MD, Centro Hospitalar de São João, Porto, Portugal, and published online in Clinical Gastroenterology and Hepatology.
LIMITATIONS:
The single-center study design may have limited the generalizability of the findings. The study lacked comparison with hepatic venous pressure gradient measurements, which are the gold standard for diagnosing portal hypertension. The relatively short follow-up duration and exclusion of patients on nonselective beta-blockers could have introduced bias.
DISCLOSURES:
The authors reported no conflicts of interest. No financial support was provided for this study.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
