title: Measuring spleen stiffness to predict varices in chronic hepatitis B cirrhotic patients with or without receiving non-selective beta-blockers.
abstract: OBJECTIVE
  we aimed to investigate the accuracy of liver (LSM) spleen stiffness measurement (SSM) with transient elastography (TE) to predict varices in the presence of non-selective beta-blockers (NSBB).
  
  
  METHODS
  In this cross-sectional study of consecutive patients with chronic hepatitis B (CHB) and cirrhosis, all patients underwent TE and upper endoscopic examinations. LSM and SSM in predicting varices in patients receiving and not receiving NSBB were evaluated.
  
  
  RESULTS
  Altogether 144 CHB patients (29 receiving NSBB; 35 with any varices, 31 and 11 with esophageal and gastric varices, respectively) were recruited. Their mean LSM and SSM were 13.3 ± 9.0 kPa and 32.8 ± 19.2 kPa, respectively. The correlation between LSM and SSM was better in the NSBB subgroup (r = 0.525, P = 0.003) than its counterpart (r = 0.329, P  < 0.001). The area under receiver operating characteristic curve (AUROC) of LSM and SSM for any varices was 0.675 and 0.685 (P = 0.002 and 0.001), respectively. SSM of 18.9 kPa had a negative predictive value of 92.1% and negative likelihood ratio of 0.27 for ruling out any varices; and SSM of 54.9 kPa had a positive predictive value of 56.5% and a positive likelihood ratio of 4.05 to rule in varices. The AUROC of LSM for varices was 0.742 and 0.549 in patients with or without NSBB, respectively; the corresponding AUROC of SSM was 0.572 and 0.603, respectively.
  
  
  CONCLUSIONS
  SSM only has modest accuracy to predict varices independent of NSBB use. An SSM cutoff value of 18.9 kPa may be adopted to achieve a high negative predictive value to rule out varices.
authors.affiliation: Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong SAR, China.|Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China.|State Key Laboratory of Digestive Disease, Chinese University of Hong Kong, Hong Kong SAR, China.
authors.forename: Grace Lai-Hung
authors.initials: GL
authors.lastname: Wong
authors.affiliation: Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong SAR, China.|Department of Gastroenterology and Hepatology, Concord Repatriation Hospital, Sydney, Australia.
authors.forename: Raymond
authors.initials: R
authors.lastname: Kwok
authors.affiliation: Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong SAR, China.|Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China.|State Key Laboratory of Digestive Disease, Chinese University of Hong Kong, Hong Kong SAR, China.
authors.forename: Henry Lik-Yuen
authors.initials: HL
authors.lastname: Chan
authors.affiliation: Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China.
authors.forename: Stephen Pui-Kit
authors.initials: SP
authors.lastname: Tang
authors.affiliation: Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China.
authors.forename: Eugenia
authors.initials: E
authors.lastname: Lee
authors.affiliation: Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China.
authors.forename: Thomas Chi-Ho
authors.initials: TC
authors.lastname: Lam
authors.affiliation: Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China.
authors.forename: Tiffany Wing-Yan
authors.initials: TW
authors.lastname: Lau
authors.affiliation: Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China.
authors.forename: Teresa Man-Kee
authors.initials: TM
authors.lastname: Ma
authors.affiliation: Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China.
authors.forename: Betsy Chi-Kuen
authors.initials: BC
authors.lastname: Wong
authors.affiliation: Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong SAR, China. wongv@cuhk.edu.hk.|Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China. wongv@cuhk.edu.hk.|State Key Laboratory of Digestive Disease, Chinese University of Hong Kong, Hong Kong SAR, China. wongv@cuhk.edu.hk.
authors.forename: Vincent Wai-Sun
authors.initials: VW
authors.lastname: Wong
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D054459:Elasticity Imaging Techniques / Q000379:methods; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000209:etiology; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging; D008103:Liver Cirrhosis / Q000150:complications / Q000821:virology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013154:Spleen / Q000000981:diagnostic imaging*; D013163:Splenomegaly / Q000000981:diagnostic imaging / Q000209:etiology
chemical_list: D000319:Adrenergic beta-Antagonists; D000998:Antiviral Agents
keywords: cirrhosis; splenomegaly; transient elastography; varices