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Spleen stiffness can predict liver decompensation and survival in patients with cirrhosis
Author(s) -
Karagiannakis Dimitrios S.,
Voulgaris Theodoros,
Markakis George,
Lakiotaki Dimitra,
Michailidou Elisavet,
Cholongitas Evangelos,
Papatheodoridis George
Publication year - 2023
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.16057
Subject(s) - medicine , decompensation , liver transplantation , cirrhosis , gastroenterology , proportional hazards model , transient elastography , transplantation , surgery , liver fibrosis
Background and Aim Liver stiffness measurement (LSM) has been predicting liver decompensation and survival in cirrhotics. The aim of our study was to investigate if spleen stiffness measurement (SSM) by 2D shear‐wave elastography could predict better the probability of decompensation and mortality, compared with LSM and other parameters. Methods Consecutive cirrhotic patients were recruited between 1/2017 and 12/2021. LSM and SSM were performed at baseline and epidemiological, clinical, and laboratory data were collected. Clinical events were recorded every 3 months. Results Totally, 177 patients were followed for a mean period of 31 ± 18 months. In Cox regression analysis, only SSM was independently associated with the probability of decompensation (HR: 1.063, 95% CI: 1.009–1.120; P = 0.021), offering an AUROC of 0.710 ( P = 0.003) for predicting 1‐year liver decompensation (NPV: 81.1% for the cut‐off point of 37 kPa). The occurrence of death/liver transplantation was independently associated only with higher SSM (HR: 1.043; 95% CI:1.003–1.084; P = 0.034). The AUROC of SSM for predicting 1‐year death/liver transplantation was 0.72 ( P = 0.006) (NPV: 95% for the cut‐off of 38.8 kPa). The performance of SSM to predict the 1‐year death/liver transplantation increased in high‐risk patients (CTP: B/C plus MELD >10 plus LSM > 20 kPa), giving an AUROC of 0.80 ( P < 0.001). Only 1/26 high‐risk patients with SSM < 38.8 kPa died during the first year of follow‐up (NPV: 96.4%). Conclusions SSM was the only factor independently associated with the probability of decompensation and occurrence of death, showing better diagnostic accuracy for the prediction of 1‐year decompensation or death compared with LSM and MELD score.