Spleen Stiffness Can Predict Liver-Related Outcomes in Patients with Cirrhosis

Summary and Comment |
January 13, 2017

Spleen Stiffness Can Predict Liver-Related Outcomes in Patients with Cirrhosis

  1. Atif Zaman, MD, MPH

A promising noninvasive prognostic measure of hepatic decompensation and mortality

  1. Atif Zaman, MD, MPH

Early identification of hepatic decompensation is important in appropriately timing liver transplantation referral, and a major component of prognosis is development of portal hypertension. Currently, the best tool to determine portal hypertension is measurement of the hepatic venous pressure gradient, which requires technical skills and is invasive.

To evaluate the performance of an alternative measure — spleen stiffness — in predicting hepatic decompensation and mortality in this setting, investigators in Japan prospectively evaluated 393 patients using acoustic radiation force impulse imaging to evaluate spleen stiffness, laboratory testing, and endoscopy every 3–6 months until death, liver transplantation, or study end.

During a median follow-up of 45 months, 67 patients died and 35 developed decompensation. In multivariate analysis, including adjustment for variables such as the model for end-stage liver disease (MELD) and Child-Pugh scores, spleen stiffness was an independent predictor of mortality (hazard ratio, 14.5) and hepatic decompensation (HR, 14.5) and had the greatest predictive accuracy of all tested variables (area under the receiver operating characteristic curve, 0.83 for mortality and 0.84 for decompensation). At a cutoff value of 3.43 m/s, spleen stiffness had a negative predictive value and predictive accuracy for mortality of 95.4% and 75.8%, respectively, and, at a cutoff of 3.25 m/s, of 98.8% and 68.9%, respectively, for decompensation. The positive predictive value was poor for both mortality and decompensation (39.6% and 28.0%, respectively).

Comment

Spleen stiffness likely reflects degree of portal hypertension. Once future studies validate these results, we can potentially fine-tune prognosis in patients with cirrhosis by adding spleen stiffness results to liver function scoring tools such as MELD.

Note to readers: At the time NEJM Journal Watch reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

Editor Disclosures at Time of Publication

  • Disclosures for Atif Zaman, MD, MPH at time of publication Nothing to disclose

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