Real-World Performance of Transient Elastography for Liver and Spleen Stiffness in Tertiary Care

Evaluating Non-Invasive Predictors of Clinically Significant Portal Hypertension (CSPH)

Clinically significant portal hypertension (CSPH), defined by a hepatic venous pressure gradient (HVPG) ≥10 mm Hg, is a key risk factor for complications like variceal bleeding in decompensated cirrhosis.

While liver stiffness measurement (LSM) via vibration-controlled transient elastography (VCTE) is the standard non-invasive method for predicting CSPH, spleen stiffness measurement (SSM) has emerged as a promising alternative.

Supported by the Baveno group, SSM offers potential advantages, including higher sensitivity and specificity for CSPH detection and reduced susceptibility to hepatic inflammation interference.

This study evaluates the real-world performance of LSM alone and in combination with SSM for CSPH prediction.

Methods

Study Design:

Retrospective chart review of adult patients at a tertiary center (May–October 2023).

Data Collected:

Demographics, liver stiffness measurement (LSM), spleen stiffness measurement (SSM), endoscopy, imaging, and lab results.

Inclusion Criteria:

Patients with cirrhosis.

Completed LSM via VCTE.

Abdominal imaging ± upper endoscopy within 6 months of VCTE.

Definition of CSPH:

Findings of portal hypertension on imaging and/or endoscopy.

Exclusion Criteria:s

Age <18 years.

Cardiac cirrhosis.

Variceal banding within 2 years prior to VCTE.

Non-selective beta-blocker use at the time of VCTE.

Analysis Performed:

Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of LSM and

SSM cut-offs for CSPH prediction.

Results Summary

Patient Population:

A total of 919 VCTE procedures were conducted, with 119 patients included in the study. Among these, 67 patients underwent SSM, and 40 were diagnosed with CSPH. The etiologies of liver disease were alcohol-related (44%), MASLD (36%), and viral hepatitis (6%).

Sensitivity for CSPH Prediction:

SSM (using kPa cut-offs):

At 30 kPa: Sensitivity was 0.96.

At 35 kPa: Sensitivity was 0.88.

LSM: Sensitivity data not provided explicitly in the results summary.

Thrombocytopenia:

Platelet count <150/μL: Sensitivity was 0.50.

Platelet count <100/μL: Sensitivity was 0.29.

Specificity for CSPH Prediction:

SSM (using kPa cut-offs):

At 30 kPa: Specificity was 0.10.

At 35 kPa: Specificity was 0.20.

At 40 kPa: Specificity was 0.39.

At 45 kPa: Specificity was 0.59.

LSM:

At 20 kPa: Specificity was 0.24.

Thrombocytopenia:

Platelet count <150/μL: Specificity was 0.61.

Platelet count <100/μL: Specificity was 0.90.

Key Insight

In this preliminary single-center study, spleen stiffness measurement (SSM) >40 kPa demonstrated comparable sensitivity and greater specificity compared to liver stiffness measurement (LSM) >20 kPa for identifying patients with CSPH.

Future analysis will explore whether combining LSM, SSM and other variables like platelet counts enhances CSPH prediction and whether these associations vary by cirrhosis etiology. Ongoing data collection and analysis will provide further insights.

By - Eeshan Aggarwal

Reference: Hepatology. Volume 80, Issue S1. Abstract Supplement for The Liver Meeting by the American Association for the Study of Liver Diseases (AASLD), November 15-19, 2024, San Diego, CA.