Friday, September 7, 2012

Spleen stiffness evaluated portal hypertension, indicated esophageal varices in cirrhosis patients

Spleen stiffness evaluated portal hypertension, indicated esophageal varices in cirrhosis patients

Colecchia A. Gastroenterology. 2012;143:646-654.

September 7, 2012

Results from a recent study suggest that measurement of spleen stiffness can be a noninvasive method of assessing portal hypertension and detecting esophageal varices in patients with HCV-induced cirrhosis.

Researchers evaluated the spleen stiffness (SS) and liver stiffness (LS) in 100 patients with HCV-induced cirrhosis. SS was measured via transient elastography (TE), and the effectiveness of this parameter in diagnosing portal hypertension (PH) and esophageal varices (EV) within the cohort was compared with LS and other noninvasive methods, including the LS-spleen diameter to platelet ratio score (LSPS) and the platelet count to spleen diameter ratio (Plt/Spl).

Esophageal varices were present in 53 participants, including 27 with grade I, 20 with grade II and six with grade III. All patients had hepatic vein pressure gradients (HVPG) of more than 5 mm Hg. Clinically significant portal hypertension was present in 65 patients, with 54 cases considered severe (12 mm Hg or greater).

SS measurements were significantly higher in patients with EV compared with those without (58.6 kPa vs. 39 kPa), and among those with clinically significant PH compared with those with preclinical hypertension (n=35) (56 kPa vs. 37 kPa). Investigators observed correlations between results from different testing methods and HVPG, with the strongest between HVPG and SS (r=0.885) and LS (r=0.836) (P=.0001 for both), and found that the best predictive model for HVPG included both LS and SS (R2=0.85, P<.0001).

AUROC analysis indicated significant differences between SS and other evaluated tests in diagnosing the following:

  • Presence of EV: AUROC=0.941 for SS compared with 0.857 for Plt/Spl (P=.05)
  • HVPG of 10 mm Hg or higher: AUROC=0.966 for SS compared with 0.907 for LSPS (P=.05) and with 0.847 for Plt/Spl (P=.007)
  • HVPG of 12 mm Hg or higher: AUROC=0.959 for SS compared with 0.899 for LSPS (P=.048) and with 0.828 for Plt/Spl (P=.003)
No significant difference was observed between SS and LS in the AUROC for any diagnoses.
“The results of the present study provide advancement and a wide insight into the relevant diagnostic potential of TE in the clinical setting of HCV-induced cirrhosis,” the researchers wrote. “In particular, they suggest for the first time that introduction of SS measurement, possibly associated with LS, may enable clinicians to monitor the evolution of PH from early to late cirrhosis, including the occurrence of EV.”

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