title: Measurement of Spleen Stiffness With Acoustic Radiation Force Impulse Imaging Predicts Mortality and Hepatic Decompensation in Patients With Liver Cirrhosis.
abstract: OBJECTIVE
  Hepatic venous pressure gradient can predict mortality and hepatic decompensation in patients with cirrhosis. Measurement of hepatic venous pressure gradient requires an invasive procedure; therefore, prognostic markers are needed that do not require invasive procedures. We investigated whether measurements of spleen stiffness, made by acoustic radiation force impulse (ARFI) imaging, associated with mortality and decompensation in patients with cirrhosis, compared with liver stiffness and other markers.
  
  
  METHODS
  We measured spleen stiffness in 393 patients diagnosed with cirrhosis (based on histologic or physical, laboratory, and radiologic findings) at a hospital in Japan from September 2010 through August 2013 (280 patients with compensated and 113 patients with decompensated cirrhosis). Patients underwent biochemical, ARFI, ultrasonography, and endoscopy evaluations every 3 or 6 months to screen for liver-related complications until their death, liver transplantation, or the end of the study period (October 2015). The primary outcome was the accuracy of spleen stiffness in predicting mortality and decompensation, measured by Cox proportional hazards model analysis. We compared spleen stiffness with other noninvasive parameters using the Harrell's C-index analysis.
  
  
  RESULTS
  During a median follow-up period of 44.6 months, 67 patients died and 35 patients developed hepatic decompensation. In the multivariate analysis, spleen stiffness was an independent parameter associated with mortality, after adjustment for levels of alanine aminotransferase and serum sodium, and the model for end-stage liver disease score (P < .001). Spleen stiffness was associated independently with decompensation after adjustment for Child-Pugh score and model for end-stage liver disease score (P < .001). Spleen stiffness predicted mortality and decompensation with greater accuracy than other parameters (C-indexes for predicting mortality and decompensation were 0.824 and 0.843, respectively). A spleen stiffness cut-off value of 3.43 m/s identified the death of patients with a 95.3% negative predictive value and 75.8% accuracy. A spleen stiffness cut-off value of 3.25 m/s identified patients with decompensation with a 98.8% negative predictive value and 68.9% accuracy.
  
  
  CONCLUSIONS
  Spleen stiffness, measured by ARFI imaging, can predict death of patients with cirrhosis with almost 76% accuracy and hepatic decompensation with almost 70% accuracy. It might be a useful noninvasive test to predict patient outcome. UMIN Clinical Trials Registry no. UMIN000004363.
authors.affiliation: Department of Internal Medicine, Hiroshima City Hospital, Hiroshima, Japan; Department of Gastroenterology, Kurashiki Central Hospital, Okayama, Japan. Electronic address: takuma@enjoy.ne.jp.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Takuma
authors.affiliation: Department of Gastroenterology, Kurashiki Central Hospital, Okayama, Japan.
authors.forename: Youichi
authors.initials: Y
authors.lastname: Morimoto
authors.affiliation: Department of Gastroenterology, Kurashiki Central Hospital, Okayama, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Takabatake
authors.affiliation: Department of Gastroenterology, Kanazawa Medical University, Ishikawa, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Toshikuni
authors.affiliation: Department of Laboratory Medicine, Kurashiki Central Hospital, Okayama, Japan.
authors.forename: Junko
authors.initials: J
authors.lastname: Tomokuni
authors.affiliation: Department of Laboratory Medicine, Kurashiki Central Hospital, Okayama, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Sahara
authors.affiliation: Department of Gastroenterology, Kurashiki Central Hospital, Okayama, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Matsueda
authors.affiliation: Department of Gastroenterology, Kurashiki Central Hospital, Okayama, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamamoto
mesh_terms: D000368:Aged; D054459:Elasticity Imaging Techniques; D005260:Female; D006801:Humans; D007564:Japan; D008103:Liver Cirrhosis / Q000150:complications*; D017093:Liver Failure / Q000175:diagnosis* / Q000401:mortality*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D013154:Spleen / Q000000981:diagnostic imaging* / Q000473:pathology*; D016019:Survival Analysis
keywords: ARFI; Acoustic Radiation Force Impulse; Decompensation; Fibrosis; MELD; Mortality; Prediction; Prognosis; Spleen Stiffness