Early diagnostic value of liver stiffness measurement in hepatic sinusoidal obstruction syndrome induced by hematopoietic stem cell transplantation

Table 1 Revised Seattle, Baltimore, and European Society for bone marrow transplantation diagnostic criteria for hepatic sinusoidal obstruction syndrome

Standard	Definition
Revised Seattle standard	At least two of the following manifestations occurred within 20 d after HSCT: Bilirubin > 2 mg/dL, hepatomegaly with right upper abdominal pain, fluid retention, and weight gain ≥ 2% of baseline weight
Baltimore standard	At least two of the following manifestations occurred within 21 d after HSCT: Bilirubin > 2 mg/dL, hepatomegaly with right upper abdominal pain, fluid retention, and weight gain ≥ 5% of baseline weight
EBMT standard	Classic SOS: Bilirubin > 2 mg/dL within 21 d after HSCT, and at least two of the following manifestations are met: painful hepatomegaly, weight gain ≥ 5%, ascites
	Delayed type of SOS: 21 d after HSCT, there was classical SOS or SOS confirmed by pathology, or ≥ 2 classical criteria with ultrasonic or hemodynamic evidence

HSCT: Hematopoietic stem cell transplantation; SOS: Sinusoidal obstruction syndrome.

Table 2 New European society for Blood and Marrow Transplantation criteria for severity grading of a suspected sinusoidal obstruction syndrome in adults

	Mild	Moderate	Severe	Very severe - MOD/MOF
Time since first clinical symptoms of SOS/VOD	> 7 d	5-7 d	≤ 4 d	Any time
Bilirubin (mg/dL)	≥ 2 and < 3	≥ 3 and < 5	≥ 5 and < 8	≥ 8
Bilirubin (μmol/L)	≥ 34 and < 51	≥ 51 and < 85	≥ 85 and < 136	≥ 136
Bilirubin kinetics			Doubling within 48 h
Transaminases	≤ 2 ULN	> 2 and ≤ 5 ULN	> 5 and ≤ 8 ULN	> 8 ULN
Weight increase	< 5%	≥ 5% and < 10%	≥ 5% and < 10%	≥ 10%
Renal function	< 1.2 × baseline at transplant	≥ 1.2 and < 1.5 × baseline at transplant	≥ 1.5 and < 2 × baseline at transplant	≥ 2 × baseline at transplant

MOD: Multi-organ dysfunction; MOF: Multi-organ failure; SOS: Sinusoidal obstruction syndrome; VOD: Veno-occlusive disease; ULN: Upper limit of normal.

Table 3 Liver stiffness measurement allows early diagnosis of veno-occlusive disease/sinusoidal obstruction syndrome in patients who undergo hematopoietic stem cell transplantation

Country	Year	Study design	Age	HSCT patients (n)	SOS patients (n)	LSM method	LSM (baseline)	LSM (peak)	AUC	Sensitivity	Specificity	Ref.
Italy	2019	Prospective	Adult	78	4	FibroScan	3.7-8.8	15-34.3	0.997	75%	98.70%	Colecchia et al[86]
Italy	2016	Retrospective	Children	22	4	FibroScan	4-6	12-20				Colecchia et al[87]
Italy	2022	Prospective	Adult	21	2	FibroScan	6.7	> 21 kPa				Ravaioli et al[85]
Turkey	2022	Prospective	61 yr, 65 yr	31	2	FibroScan	8.2	55, 17.7	0.569	100%	55.17%	Özkan et al[92]
United States	2017	Prospective	Adult	25	5	SWE	0.02 ± 0.18 m/s	0.25 ± 0.21 m/s	0.7762	80%	67%	Reddivalla et al[84]
France	2021	Retrospective	Adult	146	6	2D-SWE		> 8.1 kPa	0.84	75%	99%	Debureauxet al[93]
Spain	2011	Retrospective	Adult		2	ARFI		2.75 m/s, 2.58 m/s				Fontanilla et al[79]
Italy	2019	Retrospective	Children	-	3	FibroScan	2.8-4.6	34.3-36	-	-	-	Zama et al[94]

AUC: Area under the curve; 2D-SWE: Two-dimensional-shear wave elastography; ARFI: Acoustic radiation force impulse; HSCT: Hematopoietic stem cell transplantation; SOS: Sinusoidal obstruction syndrome; LSM: Liver stiffness measurement.