title: Spleen enlargement on follow-up evaluation: a noninvasive predictor of complications of portal hypertension in cirrhosis.
abstract: OBJECTIVE
  Splenomegaly is observed in most but not all patients with cirrhosis, and has been detected more often in patients showing complications of portal hypertension. We aimed to test the hypotheses that spleen enlarges over time in cirrhosis, and that a progressive enlargement may be associated with portal hypertension-related events.
  
  
  METHODS
  A total of 127 cirrhotic patients (Child-Pugh, 6.7 +/- 1.7; range, 5-11), observed at our center and followed-up clinically, endoscopically, and with periodic abdominal ultrasound for at least 1 year, were included. Spleen diameter was recorded at each ultrasound examination. The change of spleen diameter over time was calculated. The occurrence of clinical complications of cirrhosis on follow-up evaluation was recorded.
  
  
  RESULTS
  At inclusion, spleen diameter was 14.9 +/- 3.1 cm; 83% of the patients had splenomegaly. Spleen was larger in patients with decompensated disease (n = 39) versus patients with compensated disease (n = 88) (16.1 +/- 3.5 vs 14.5 +/- 2.7; P = .012). The mean follow-up period was 53 +/- 37 months. Spleen progressively enlarged over time (analysis of variance, P < .0001). A total of 46.4% of patients showed a spleen enlargement of 1 cm or more at 1 year. Over 5 years of follow-up evaluation patients showing spleen enlargement showed a higher actuarial probability of esophageal varices formation (84.6% vs 16.6%; P = .001) and growth (63.3% vs 20.6%; P = .001). Among patients with compensated cirrhosis at inclusion, those showing a spleen enlargement had a higher actuarial probability of developing the first clinical decompensation of cirrhosis (51.1% vs 19.5%, P = .002).
  
  
  CONCLUSIONS
  Spleen enlargement at follow-up evaluation outlines a subgroup of cirrhotic patients at higher risk of complications of portal hypertension. Noninvasive monitoring of spleen diameter allows a prognostic stratification of cirrhotic patients.
authors.affiliation: Dipartimento di Medicina Interna, Cardioangiologia, Epatologia, Università di Bologna, Bologna, Italy. aberzigo@clinic.ub.es
authors.forename: Annalisa
authors.initials: A
authors.lastname: Berzigotti
authors.forename: Paola
authors.initials: P
authors.lastname: Zappoli
authors.forename: Donatella
authors.initials: D
authors.lastname: Magalotti
authors.forename: Carolina
authors.initials: C
authors.lastname: Tiani
authors.forename: Valentina
authors.initials: V
authors.lastname: Rossi
authors.forename: Marco
authors.initials: M
authors.lastname: Zoli
mesh_terms: D000005:Abdomen / Q000000981:diagnostic imaging; D000368:Aged; D004932:Esophageal and Gastric Varices / Q000473:pathology; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications* / Q000175:diagnosis; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012720:Severity of Illness Index; D013163:Splenomegaly; D014463:Ultrasonography