Ravaioli F, Colecchia A, Dajti E, Marasco G, Alemanni LV, Tamè M, Azzaroli F, Brillanti S, Mazzella G, Festi D. Spleen stiffness mirrors changes in portal hypertension after successful interferon-free therapy in chronic-hepatitis C virus patients. World J Hepatol 2018; 10(10): 731-742 [PMID: 30386466 DOI: 10.4254/wjh.v10.i10.731]
Corresponding Author of This Article
Antonio Colecchia, MD, Unit of Gastroenterology, Borgo Trento University Hospital, Verona 37100, Italy. antonio.colecchia@aovr.veneto.it
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Oct 27, 2018; 10(10): 731-742 Published online Oct 27, 2018. doi: 10.4254/wjh.v10.i10.731
Spleen stiffness mirrors changes in portal hypertension after successful interferon-free therapy in chronic-hepatitis C virus patients
Federico Ravaioli, Antonio Colecchia, Elton Dajti, Giovanni Marasco, Luigina Vanessa Alemanni, Mariarosa Tamè, Francesco Azzaroli, Stefano Brillanti, Giuseppe Mazzella, Davide Festi
Federico Ravaioli, Antonio Colecchia, Elton Dajti, Giovanni Marasco, Luigina Vanessa Alemanni, Mariarosa Tamè, Francesco Azzaroli, Stefano Brillanti, Giuseppe Mazzella, Davide Festi, Gastroenterology Unit, Sant’Orsola-Malpighi University Hospital, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna 40138, Italy
Antonio Colecchia, Unit of Gastroenterology, Borgo Trento University Hospital, Verona 37100, Italy
Author contributions: Ravaioli F, Dajti E, Marasco G and Alemanni V collected data, analysed data, wrote the manuscript, approved the final manuscript; Tamè M, Azzaroli F, Brillanti S and Mazzella G analysed data and contributed to the drafting and final approval of the manuscript; Colecchia A, Mazzella G and Festi D provided overall oversight of the study, analysed data and contributed to the drafting and final approval of the manuscript.
Institutional review board statement: This study was approved by the National Institutional Review Board of the Italian Medicines Agency Committee. Local IRB [Institutional Ethics Committee of Sant’Orsola-Malpighi University Hospital (Bologna, Italy)] approval was authorized.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous data that were obtained after each patient agreed to treatment by written consent.
STROBE statement: The guidelines of the STROBE statement have been adopted and a fulfilled version of the checklist has been attached with the submission of the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Antonio Colecchia, MD, Unit of Gastroenterology, Borgo Trento University Hospital, Verona 37100, Italy. antonio.colecchia@aovr.veneto.it
Telephone: +39-335-5876834 Fax: +39-51-2144111
Received: July 3, 2018 Peer-review started: July 3, 2018 First decision: July 24, 2018 Revised: July 27, 2018 Accepted: August 12, 2018 Article in press: August 13, 2018 Published online: October 27, 2018 Processing time: 116 Days and 14.5 Hours
Abstract
AIM
To investigate changes in spleen stiffness measurements (SSMs) and other non-invasive tests (NITs) after treatment with direct-acting antivirals (DAAs) and identify predictors of SSM change after sustained virological response (SVR).
METHODS
We retrospectively analysed 146 advanced-chronic liver disease (ACLD) patients treated with DAA with available paired SSM at baseline and SVR24. Liver stiffness (LSM), spleen diameter (SD), platelet count (PLT) and liver stiffness-spleen diameter to platelet ratio score(LSPS) were also investigated. LSM ≥ 21 kPa was used as a cut-off to rule-in clinically significant portal hypertension (CSPH). SSM reduction > 20% from baseline was defined as significant.
RESULTS
SSM significantly decreased at SVR24, in both patients with and without CSPH; in 44.8% of cases, SSM reduction was > 20%. LSPS significantly improved in the entire cohort at SVR24; SD and PLT changed significantly only in patients without CSPH. LSM significantly decreased in 65.7% of patients and also in 2/3 patients in whom SSM did not decrease. The independent predictor of decreased SSM was median relative change of LSM. CSPH persisted in 54.4% patients after SVR. Delta LSM and baseline SSM were independent factors associated with CSPH persistence.
CONCLUSION
SSM and other NITs significantly decrease after SVR, although differently according to the patient’s clinical condition. SSM faithfully reflects changes in portal hypertension and could represent a useful NIT for the follow-up of these patients.
Core tip: Liver stiffness measurement (LSM) and spleen stiffness measurement (SSM) are widely validated surrogates of portal hypertension (PH) and its complications. Their role in the assessment of therapy response, such as treatment with direct-acting antivirals (DAAs) of hepatitis C virus patients, is still under investigation. We demonstrated in a large cohort that not only LSM, but also SSM, is reduced six months after successful DAA therapy. As opposed to LSM, SSM directly reflects PH and is less influenced by the immediate reduction of liver necro-inflammation. We believe that SSM could represent a helpful tool for the clinician in the follow-up of these patients.
