Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Nov 27, 2020; 12(11): 1055-1066
Published online Nov 27, 2020. doi: 10.4254/wjh.v12.i11.1055
Non-invasive splenic parameters of portal hypertension: Assessment and utility
Ayesha Karim Ahmad, Sebastiana Atzori, James Maurice, Simon D Taylor-Robinson, Adrian KP Lim
Ayesha Karim Ahmad, Liver Unit, Department of Digestion, Metabolism & Reproduction, Faculty of Medicine, Imperial College London, London W2 1NY, United Kingdom
Sebastiana Atzori, James Maurice, Simon D Taylor-Robinson, Liver Unit, Department of Digestion, Metabolism & Reproduction, Imperial College London, London W2 1NY, United Kingdom
Adrian KP Lim, Liver Unit and Imaging, Department of Digestion, Metabolism & Reproduction, Imperial College London, London W2 1NY, United Kingdom
Author contributions: Ahmad AK collected data, performed statistical analyses, wrote the manuscript with support from other authors; Atzori S performed the experiments and statistical analyses; Maurice J critically appraised study design; Taylor-Robinson SD and Lim AKP designed, supervised and implemented the research; all authors discussed the results and contributed to the final manuscript.
Institutional review board statement: This study was performed in accordance with the 1975 Declaration of Helsinki, with approvals from the Research Ethics Committee and the Joint Research and Compliance Office of Imperial College London and Imperial College Healthcare NHS Trust.
Informed consent statement: Patients were required to give informed consent to the study in the form of written consent.
Conflict-of-interest statement: This work was supported by Philips Medical Systems (Seattle, Washington, United States); United Kingdom National Institute for Health Research Biomedical Facility at Imperial College London, London, United Kingdom.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Adrian KP Lim, MD FRCR, Doctor, Liver Unit and Imaging, Department of Digestion, Metabolism & Reproduction, Imperial College London, London W2 1NY, United Kingdom. a.lim@imperial.ac.uk
Received: July 16, 2020
Peer-review started: July 16, 2020
First decision: August 9, 2020
Revised: August 22, 2020
Accepted: October 9, 2020
Article in press: October 9, 2020
Published online: November 27, 2020
Processing time: 130 Days and 15.1 Hours
Abstract
BACKGROUND

Portal hypertension is a major complication of cirrhosis that is associated with significant morbidity and mortality. The present gold-standard method to risk stratify and observe cirrhosis patients with portal hypertension is hepatic venous pressure gradient measurement or esophagogastroduodenoscopy. However, these methods are invasive, carry a risk of complications and are associated with significant patient discomfort. Therefore, non-invasive splenic parameters are of clinical interest as potential useful markers in determining the presence of portal hypertension. However, diagnostic accuracy and reproducibility remains unvalidated.

AIM

To assess the diagnostic accuracy of spleen stiffness, area and diameter in predicting the presence of portal hypertension.

METHODS

Of 50 patients with varying liver disease pathologies were prospectively recruited from the St. Mary’s Hospital Liver Unit in London; 25 with evidence of portal hypertension and 25 with no evidence of portal hypertension. Liver stiffness, spleen stiffness, spleen diameter and spleen area were measured using the Philips Affiniti 70 elastography point quantification point shear wave elastography system. The aspartate aminotransferase-to-platelet-ratio-index (APRI) score was also calculated. Performance measures, univariate and multivariate logistic regression were used to evaluate demographic, clinical and elastography variables. Interclass correlation coefficient was used to determine the reproducibility of splenic area and diameter.

RESULTS

On univariate and individual performance, platelet count [area under the receiver operating characteristic (AUROC) 0.846, P value < 0.001], spleen area (AUROC 0.828, P value = 0.002) and APRI score (AUROC 0.827, P value < 0.001) were the most accurate variables in identifying the presence of portal hypertension. On multivariate logistic regression models constructed, the combination of spleen area greater than 57.90 cm2 and platelet count less than 126 × 109 had 63.2% sensitivity and 100% specificity, 100% positive predictive value and 100% negative predictive value. An alternative combination of spleen stiffness greater than 29.99 kPa and platelet count less than 126 × 109 had 88% sensitivity, 75% specificity, 78.6% positive predictive value and 85.7% negative predictive value. An interclass correlation coefficient value of 0.98 (95%CI: 0.94-0.99, P value < 0.001) and 0.96 (95%CI: 0.91-0.99, P value < 0.001) were determined for inter-operator variability for spleen area and diameter respectively.

CONCLUSION

Spleen area, spleen stiffness and platelet count may be useful markers to assess the presence of portal hypertension in patients of various etiologies.

Keywords: Portal hypertension; Esophageal varices; Point shear wave elastography; Spleen stiffness; Spleen area; Non-invasive

Core Tip: Non-invasive splenic parameters are useful surrogate markers of portal hypertension (PH). A combination of spleen diameter, spleen area, liver stiffness and aspartate aminotransferase-to-platelet-ratio-index (APRI) score is able to predict the presence of PH. The APRI score has a similar diagnostic accuracy to combination index.