Spleen stiffness predicts the risk of liver-related complications in patients with compensated advanced chronic liver disease.
Objective: The development of portal hypertension (PH) is a key prognostic factor in patients with compensated advanced chronic liver disease (cACLD). The gold standard for assessing PH is the hepatic venous pressure gradient measurement. However, non-invasive tools have gained significant importance in recent years, mainly liver stiffness measurement(LSM) by vibration-controlled transient elastography (VCTE). Spleen stiffness measurement (SSM) by VCTE using a dedicated 100 Hz module has emerged as a promising non-invasive diagnostic tool, although data on its prognostic value remain limited. This study aimed to evaluate the accuracy of SSM, as measured by transient elastography, in predicting the risk of liver decompensation.
Methods: A prospective study was conducted including cACLD patients followed at a tertiary center from January 2020 toApril 2024.All patients underwent liver and spleen vibration-controlled transient elastography (utilizing the 100 Hz module) performed by the same blinded operator. Patients were subsequently monitored at the same institution for the development of PH complications.
Results: The study included 242 patients with cACLD, with a mean age of 63.0±10.5 years,78.5% male. The most common etiology was alcoholic liver disease (62.0%). The median LSM value was 21.9 kPa [15.0-34.0] and the median SSM value was 38.9 kPa [28.0-58.0]. The median follow-up period was 501.5 days [343.0-725.3]. During this time, 28 patients (11.6%) developed liver decompensations, with 20 requiring hospital admission. SSM demonstrated good predictive capacity for the risk of liver decompensation (AUC 0.823(95% confidence interval:0.742-0.904)). Alongside LSM, SSM was an effective predictor of liver decompensation, with a cut-off of 50.0 kPa indicating a significantly increased risk of hepatic decompensation.
Conclusions: Non-invasive assessment using SSM may serve as an excellent tool for predicting the risk of liver-related complications and risk-stratifying patients with cACLD, thereby improving their management.