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Spleen stiffness predicts hepatic decompensation

Stephen Padilla
03 Jul 2019

Measurement of spleen stiffness (SS) may be utilized to assess the risk of a hepatic decompensation and may therefore be used a robust screening tool to identify patients who need closer monitoring, suggests a study. In addition, SS can differentiate between acute and chronic or acute on chronic liver damage.

Of the 210 patients identified, 159 had valid liver stiffness (LS) and SS measurements and were eligible for evaluation during clinical follow-up. Hepatic decompensation developed in 12 patients (SS >39 kPa; p=0.0005). [J Clin Gastroenterol 2019;53:457-463]

Use of SS could identify patients with a high risk of decompensation, particularly in a group with elevated LS. SS was significantly lower among those with comparable LS who suffered from acute liver damage than respective patients with chronic liver damage (30.97 vs 46.03 kPa; p=0.04).

Furthermore, an association was found between acute liver failure and elevated LS (16.47 kPa), but not elevated SS (30.97 kPa).

“Our study showed that patients with varices or who develop hepatic decompensation showed significantly higher LS and SS values at baseline than patients without,” researchers said. “This is in line with previous studies, which linked SS to portal hypertension.” [Gastroenterology 2012;143:646-654; Am J Gastroenterol 2013;108:1101-1107]

The finding that patients with SS <39 kPa did not develop clinical decompensation supported that from previous studies. [J Hepatol 2014;60:1158-1164; J Gastrointestin Liver Dis 2014;23:223-224]

Another significant finding of the current study was that SS could differentiate between acute and chronic or acute on chronic liver damage, and one possible explanation for this, according to researchers, is that SS, as a prognostic factor, could predict further development of the disease.

Another explanation is that SS could simply distinguish between acute and chronic liver disease. In previous studies, a transient LS increase was described in cases of acute necroinflammation or flares of chronic hepatitis. [Hepatology 2010;52:1008-1016; J Viral Hepat 2009;16:36-44; Hepatology 2008;47:380-384; Hepatol Int 2010;4:716-722]

SS does not appear to be influenced by such changes, and it may even improve LS diagnostic by eluding the former limitations in case of acute inflammation, researchers said. Patients with acute liver failure without presenting liver disease support this evidence.

“Transient elastography might become an easy, noninvasive tool in the differentiation between acute and chronic liver disease and between acute and acute on chronic liver failure, which … is important for organ allocation in … liver transplantation,” researchers said. [Dtsch Arztebl Int 2011;108:714-720]

The current study included 210 successive patients who received liver and SS measurements and a standard laboratory. There were observed for 1 year in terms of clinical signs of decompensation.

This study was limited by the relatively small patient cohort considering its variety, and patients were not required to perform a standardized procedure of examinations. Thus, patient status could not be examined as detailed as possible.

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