Non-invasive splenic parameters of portal hypertension: Assessment and utility

doi:10.4254/wjh.v12.i11.1055

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World Journal of Hepatology

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1948-5182

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Hepatol. Nov 27, 2020; 12(11): 1055-1066
Published online Nov 27, 2020. doi: 10.4254/wjh.v12.i11.1055

Table 1 Baseline characteristics of the patient population

Parameter	Mean (standard deviation) or n
Parameter	Groups 1 and 2 (n = 50)	Group 1 (n = 25)	Group 2 (n = 25)
Age	57.86 (12.22)	60.44 (9.89)	55.28 (13.90)
Sex (M:F)	31:19	15:10	16:9
BMI	29.42 (7.61)	28.59 (5.76)	30.31 (9.26)
Skin to liver capsule Distance (cm)	2.43 (0.99)	2.46 (1.01)	2.40 (0.99)
METAVIR score	3.13 (1.276)	3.74 (0.752)	2.52 (1.410)
ALD	12	7	5
NAFLD	12	4	8
ALD and NAFLD	4	3	1
HCV	2	2	0
AIH	3	0	3
Miscellaneous	17	9	9
Total bilirubin (μmol/L)	28.00 (44.728)	39.92 (60.139)	16.08 (13.108)
ALP (IU/L)	127.33 (66.902)	144.56 (75.900)	109.38 (51.679)
GGT (IU/L)	147.68 (192.683)	160.96 (166.671)	134.96 (217.570)
ALT (IU/L)	60.84 (12.219)	48.52 (29.427)	73.16 (83.490)
AST (IU/L)	62.50 (49.043)	64.88 (32.720)	60.12 (61.872)
Albumin (g/L)	34.10 (6.129)	30.88 (5.761)	37.32 (4.679)
Platelet count (× 10⁹)	151.42 (73.016)	112.16 (60.023)	190.68 (63.804)
Prothrombin time (sec)	12.572 (1.9886)	13.470 (2.2077)	11.540 (1.0007)
INR	1.184 (0.1742)	1.260 (0.1871)	1.108 (0.1222)
EGD (PH present)	25	25	0
HVPG (PH present)	5	5	0

Group 1: Population with evidence of portal hypertension; Group 2: Population with no evidence of portal hypertension. BMI: Body mass index; ALD: Aldosterone; NAFLD: Non-alcoholic fatty liver disease; HCV: Hepatitis C virus; AIH: Autoimmune hepatitis; ALP: Alkaline phosphatase; GGT: γ-glutamyl transpeptidase; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; INR: International normalized ratio; EGD: Esophago-gastroduodenoscopy; HVPG: Hepatic venous pressure gradient; PH: Portal hypertension.

Table 2 Univariate analysis showing association of clinical parameters with clinically significant portal hypertension

Variable	Odds ratio	Cut-off	P value	Estimated AUROC curve	P value of AUROC
BMI	0.969	> 26.42	0.425	0.506	0.951
ALT (IU/L)	0.993	> 94.00	0.147	0.514	0.869
AST (IU/L)	1.002	> 64.00	0.728	0.652	0.065
GGT (IU/L)	1.001	> 85.00	0.639	0.643	0.094
ALP (IU/L)	1.001	> 96.00	0.050	0.678	0.033
Bilirubin	1.037	> 11.00	0.013^a	0.722	0.007^b
Platelet count (× 10⁹)	0.979	< 126.00	< 0.001^c	0.846	< 0.001
Albumin (g/L)	0.786	< 33.00	< 0.001^c	0.820	< 0.001^c
Prothrombin time (sec)	2.721	> 12.20	< 0.001^c	0.800	< 0.001^c
APRI score	2.030	> 0.81	0.008^b	0.827	< 0.001^c
ElastPQ median liver stiffness (kPa)	1.048	> 10.16	0.021^a	0.657	0.061
ElastPQ median spleen stiffness (kPa)	1.007	> 29.99	0.368	0.712	0.010^b
ElastPQ spleen area (cm²)	1.075	> 57.90	< 0.001^c	0.828	0.002^c
ElastPQ spleen diameter (cm)	1.651	> 13.90	0.002^c	0.804	0.007^b

^aP < 0.05.

^bP < 0.01.

^cP < 0.005. AUROC: Area under the receiver operating characteristic; BMI: Body mass index; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; GGT: γ-glutamyl transpeptidase; ALP: Alkaline phosphatase; APRI: AST-to-platelet-ratio-index; ElastPQ: Elastography point quantification.

Table 3 Diagnostic performance of combination variables as predictors of clinically significant portal hypertension

Variables	AUROC curve	Sensitivity (%)	Specificity (%)	Positive predictive value (%)	Negative predictive value (%)
ElastPQ median spleen area (> 57.90 cm²) and Platelet count (< 126 × 10⁹)	0.875	63.2	100.0	100.0	61.1
ElastPQ median spleen stiffness (> 29.99 kPa) and platelet count (< 126 × 10⁹)	0.855	88.0	75.00	78.6	85.7

AUROC: Area under the receiver operating characteristic; ElastPQ: Elastography point quantification.

Table 4 One-way random intraclass coefficient values for inter-operator variability

	Spleen area	Spleen diameter
Number of operators	2	2
Number of measurements	19	19
Mean	0.98	0.96
95% confidence interval	0.94-0.99	0.91-0.99

Citation: Ahmad AK, Atzori S, Maurice J, Taylor-Robinson SD, Lim AKP. Non-invasive splenic parameters of portal hypertension: Assessment and utility. World J Hepatol 2020; 12(11): 1055-1066
URL: https://www.wjgnet.com/1948-5182/full/v12/i11/1055.htm
DOI: https://dx.doi.org/10.4254/wjh.v12.i11.1055