Measurement of spleen stiffness to evaluate portal hypertension and the presence of esophageal varices in patients with HCV-related cirrhosis.
OBJECTIVE
The hepatic vein pressure gradient (HVPG) is the standard used to determine the degree of portal hypertension (PH) and an important prognostic factor for patients with cirrhosis; HVPG values correlate with the presence of esophageal varices (EV). However, HVPG can only be accurately determined at specialized centers; noninvasive methods are needed to predict HVPG values and the presence of EV. We compared the diagnostic performance of spleen stiffness (SS) measurement by transient elastography with that of liver stiffness (LS) and of other recently proposed noninvasive tests.


METHODS
We measured SS and LS in 100 consecutive patients with hepatitis C virus-induced cirrhosis. Patients were also assessed by FibroScan, HVPG, esophagogastroduodenoscopy, and liver biopsy. We also analyzed LS-spleen diameter to platelet ratio score and platelet count to spleen diameter.


RESULTS
SS and LS were more accurate than other noninvasive parameters in identifying patients with EV and different degrees of PH. A linear model that included SS and LS accurately predicted HVPG values (R(2) = 0.85). The results were internally validated using bootstrap analysis.


CONCLUSIONS
Measurement of SS can be used for noninvasive assessment and monitoring of PH and to detect EV in patients with hepatitis C virus-induced cirrhosis.
Department of Clinical Medicine, University of Bologna, Bologna, Italy. Electronic address: antonio.colecchia@aosp.bo.it.
Antonio
A
Colecchia
Department of Clinical Medicine, University of Bologna, Bologna, Italy.
Lucia
L
Montrone
Department of Clinical Medicine, University of Bologna, Bologna, Italy.
Eleonora
E
Scaioli
Department of Cardiology, University of Bologna, Bologna, Italy.
Maria Letizia
ML
Bacchi-Reggiani
Department of Medicine, A. Manzoni Hospital, Lecco, Italy.
Agostino
A
Colli
Department of Clinical Science, University of Milan, Milan, Italy.
Giovanni
G
Casazza
Department of Clinical Medicine, University of Bologna, Bologna, Italy.
Ramona
R
Schiumerini
Department of Clinical Medicine, University of Bologna, Bologna, Italy.
Laura
L
Turco
Department of Pediatrics, University of Modena, Modena, Italy.
Anna Rita
AR
Di Biase
Department of Clinical Medicine, University of Bologna, Bologna, Italy.
Giuseppe
G
Mazzella
Department of Clinical Medicine, University of Bologna, Bologna, Italy.
Luca
L
Marzi
Department of Internal Medicine, University of Florence, Florence, Italy.
Umberto
U
Arena
Department of Internal Medicine, University of Florence, Florence, Italy; Centre for Research, High Education and Transfer "DENOThe", University of Florence, Florence, Italy.
Massimo
M
Pinzani
Department of Clinical Medicine, University of Bologna, Bologna, Italy.
Davide
D
Festi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001795:Blood Pressure Determination; D016009:Chi-Square Distribution; D054459:Elasticity Imaging Techniques; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D005260:Female; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology / Q000821:virology; D007558:Italy; D016014:Linear Models; D008099:Liver / Q000098:blood supply / Q000473:pathology* / Q000821:virology; D008103:Liver Cirrhosis / Q000821:virology*; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D017082:Portal Pressure; D011237:Predictive Value of Tests; D011379:Prognosis; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013154:Spleen / Q000473:pathology*; D013163:Splenomegaly / Q000175:diagnosis* / Q000473:pathology / Q000821:virology