Diagnostic and Clinical Implications of High Spleen-To-Liver Stiffness Ratio in MASH—A Prospective, Comparative Study

Abstract

Background

Liver stiffness measurement (LSM) and spleen stiffness measurement (SSM) represent non-invasive surrogates of portal hypertension (PH) that both correlate with hepatic venous pressure gradient (HVPG). SSM may overcome limitations of HVPG and LSM in detecting presinusoidal PH components. We investigated the SSM/LSM ratio as a PH surrogate and its relationship to HVPG and spleen diameter across different liver disease aetiologies.

Methods

399 consecutive patients with compensated liver disease undergoing same-day measurement of HVPG, LSM and SSM were prospectively included.

Results

While patients with alcohol-related liver disease (ALD; n = 200) showed higher LSM (median: 45.5 kPa) and HVPG (15.0 mmHg) than patients with metabolic dysfunction–associated steatohepatitis (MASH; n = 49; LSM: 20.9 kPa; HVPG: 12.0 mmHg), their SSM (median: 58.8 vs. 52.8 kPa; p = 0.868) was not significantly different. Consequently, the SSM/LSM ratio was higher in MASH (1.66) vs. ALD (1.28), but highest in patients with non-cirrhotic PH (3.19). When adjusting for HVPG, SSM and spleen diameter remained significantly higher in MASH than in ALD at any given HVPG.

Conclusions

This study demonstrates that SSM/LSM ratios vary across different liver disease aetiologies. Since MASH patients—after adjusting for liver disease severity—show higher SSM/LSM ratios and larger spleen diameters than ALD, our results support the concept of a presinusoidal component of PH in MASH patients.