Identification of Clinically Significant Portal Hypertension in cACLD Individuals With Spleen Stiffness Measurement

IF 6 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Liver International Pub Date : 2025-03-19 DOI:10.1111/liv.16241

Xiaofeng Zhang, Ling Zhou, Weihao Liang, Xiao Cheng, Qinjun He, Hui Li, Wenfan Luo, Jing Huang, Junying Li, Weibin Wang, Minghan Tu, Haiyu Wang, Pengcheng Ou, Biao Wen, Lushan Xiao, Damei Zhou, Vincent Wai-Sun Wong, Jinjun Chen

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Abstract

Background and Aims

The Baveno VII consensus recommends spleen stiffness measurement (SSM) for the detection of clinically significant portal hypertension (CSPH) in patients with compensated advanced chronic liver disease (cACLD). We aimed to evaluate the performance of SSM-based algorithms.

Methods

Consecutive cACLD individuals who underwent hepatic venous pressure gradient measurement, liver stiffness measurement (LSM), and SSM measured with the dedicated 100-Hz probe by vibration-controlled transient elastography were prospectively enrolled.

Results

From July 2021 to August 2024, a total of 395 patients were screened, and 185 cACLD cases were enrolled, of which 101 patients had CSPH. An SSM > 50 kPa demonstrated a positive predictive value (PPV) of 98.0% and a specificity of 98.8% for ruling in CSPH, correctly identifying 47.5% (48/101) of CSPH cases. Sensitivity analysis revealed that in 60 patients with aetiology removal or suppression, SSM > 50 kPa achieved both a PPV and specificity of 100%. Among the 125 patients with ongoing aetiologies, the PPV and specificity were 96.4% and 98.3%, respectively. Across HBV (with or without viral suppression) and non-HBV subgroups, the PPV and specificity consistently exceeded 90%. In decision curve analysis, SSM > 50 kPa provided the highest net benefit compared with other elastography-based algorithms when threshold probabilities exceeded 0.8.

Conclusions

We prospectively validated that SSM > 50 kPa, measured using the spleen-dedicated probe, is sufficient for identifying CSPH in individuals with cACLD.

Trial Registration

NCT04820166

查看原文本刊更多论文

脾僵硬度测定鉴别cACLD患者有临床意义的门脉高压

背景和目的Baveno VII共识推荐脾刚度测量（SSM）检测代偿性晚期慢性肝病（cACLD）患者的临床显著门脉高压（CSPH）。我们的目的是评估基于ssm的算法的性能。方法前瞻性纳入连续进行肝静脉压梯度测量、肝刚度测量（LSM）和SSM测量的cACLD患者，这些患者使用专用的100 hz探针进行振动控制瞬时弹性成像。结果从2021年7月至2024年8月，共筛查395例患者，纳入185例CSPH，其中101例为CSPH。SSM 50 kPa诊断CSPH的阳性预测值（PPV）为98.0%，特异性为98.8%，正确识别47.5% (48/101)CSPH病例。敏感性分析显示，在60例病因去除或抑制的患者中，SSM >； 50kpa达到了100%的PPV和特异性。在125例病因不明的患者中，PPV和特异性分别为96.4%和98.3%。在HBV（有或没有病毒抑制）和非HBV亚组中，PPV和特异性始终超过90%。在决策曲线分析中，当阈值概率超过0.8时，与其他基于弹性学的算法相比，SSM >； 50 kPa提供了最高的净效益。我们前瞻性地验证了使用脾脏专用探针测量的SSM >； 50 kPa足以识别cACLD患者的CSPH。试验注册编号NCT04820166

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Liver International 医学-胃肠肝病学

CiteScore

13.90

自引率

4.50%

发文量

348

审稿时长

2 months

期刊介绍： Liver International promotes all aspects of the science of hepatology from basic research to applied clinical studies. Providing an international forum for the publication of high-quality original research in hepatology, it is an essential resource for everyone working on normal and abnormal structure and function in the liver and its constituent cells, including clinicians and basic scientists involved in the multi-disciplinary field of hepatology. The journal welcomes articles from all fields of hepatology, which may be published as original articles, brief definitive reports, reviews, mini-reviews, images in hepatology and letters to the Editor.