Spleen stiffness can predict liver decompensation and survival in patients with cirrhosis

Abstract

AbstractBackground/AimLiver 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 to LSM and other parameters.MethodsConsecutive cirrhotic patients were recruited between 1/2017-12/2021. LSM and SSM were performed at baseline and epidemiological, clinical and laboratory data were collected. Clinical events were recorded every 3 months.ResultsTotally, 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%).ConclusionsSSM 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 to LSM and MELD score.