Spleen Stiffness May Predict Liver Decompensation, Mortality in Cirrhosis

The spleen stiffness measurement (SSM) was the only independent predictor of probability of decompensation, mortality, or liver transplant among patients with cirrhotic liver, according to study findings published in the Journal of Gastroenterology and Hepatology.

Of 196 patients identified, researchers included 177 patients with cirrhosis for the study. Researchers also performed liver stiffness measurement (LSM) and SSM at baseline and gathered epidemiological, clinical, and laboratory data. The utility of LSM and SSM as predictors for decompensation and mortality or liver transplant during a mean follow-up of 31 months were evaluated.

The patients had a mean [SD] age of 57[12] years; 62.7% were men; the average BMI was 26.4[5.1] kg/m²; Model for End-stage Liver Disease (MELD) score was 13.7[5.9]; Child-Pugh score was 6.1[1.5]; LSM was 29.2[12.6] kPa; SSM was 36.6[8.6] kPa; and 58.2% had decompensated cirrhosis. Liver disease etiologies were alcoholic liver disease (29.9%), chronic viral hepatitis (29.9%), nonalcoholic fatty liver disease (18.1%), cholestatic liver diseases (12.4%), and other (9.6%).

Among the subset of patients without decompensated liver at baseline (n=74), 40.5% developed decompensated disease during follow-up. Risk for progressing to decompensated liver was associated with LSM, SSM, platelet levels, and MELD score. In the multivariate analysis, however, only SSM remained a significant predictor (hazard ratio [HR], 1.063; 95% CI, 1.009-1.120; P =.021).

Using an SSM cutoff of 37 kPa, SSM had a sensitivity of 74.1%, specificity of 72.7%, and negative predictive value (NPV) of 81.1% for predicting liver decompensation (area under the receiver operating characteristic curve [AUROC], 0.710; P =.003).

During follow up, 26.6% of patients died and 10.7% received a liver transplant. Risk for death or liver transplant was associated with LSM, SSM, MELD score, and Child-Pugh score. As with risk for decompensation, risk for mortality or liver transplant in the multivariate analysis was associated with SSM (HR, 1.043; 95% CI, 1.003-1.084; P =.034).

With an SSM cutoff of 38.8 kPa, SSM had a sensitivity of 72%, specificity of 64%, and NPV of 95% for predicting mortality or liver transplant (AUROC, 0.72; P =.006).

Stratified by SSM of 38.8 kPa at baseline, patients with levels below the cutoff had superior transplant-free survival outcomes (mean, 52 vs 42 months; P =.05) compared with patients who had levels above the cutoff, respectively.

These data indicated that SSM was the only independent predictor for probability of decompensation and mortality or liver transplant among patients with cirrhosis.  

“If further studies confirm these results, SSM can play a crucial role in order to help physicians to determine a better strategy for preventing liver-related complications and death in patients with cirrhosis,” the researchers concluded.