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Cited by 15Liver Diseases and ImmunityLiver Disease and TransplantationLiver Disease Diagnosis and Treatment

Spleen stiffness measurement predicts decompensation and rules out high-risk oesophageal varices in primary biliary cholangitis

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Rigamonti, Cristina, Cittone, Micol Giulia, Manfredi, Giulia Francesca, De Benedittis, Carla, Paggi, Noemi, Baorda, Francesca, Di Benedetto, Davide, Minisini, Rosalba +1 more·2024·JHEP Reports
DOI 10.1016/j.jhepr.2023.100952PMC PMC10772386
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Abstract

Background & Aims Primary biliary cholangitis (PBC) may lead to portal hypertension (PH). Spleen stiffness measurement (SSM) by vibration-controlled transient elastography accurately predicts PH. We aimed to assess SSM role in stratifying the risk of liver decompensation in PBC. Methods In this monocentric, prospective, cross-sectional study, we included 114 patients with PBC who underwent liver stiffness measurement (LSM) and SSM. In total, 78 and 33 patients underwent two and three sequential vibration-controlled transient elastography examinations, respectively (longitudinal study). Screening for high-risk oesophageal varices by oesophagogastroduodenoscopy was performed according to guidelines and proposed to all patients with SSM >40 kPa. Results Among the 114 patients, 20 (17%) had LSM ≥10 kPa, whereas 17 (15%) had SSM >40 kPa. None of the patients with SSM ≤40 kPa had high-risk oesophageal varices, compared with three of 14 patients with SSM >40 kPa (21%; three refused endoscopy); any-size oesophageal varices were found in nine of 14 patients (64%). During a median follow-up of 15 months (IQR 10–31 months), five (4%) patients developed liver decompensation. The probability of liver decompensation was significantly higher among patients with both LSM ≥10 kPa and SSM >40 kPa: 41% at 24 months vs . 0% in other patient groups ( i.e. LSM <10 kPa and SSM ≤40 kPa, or LSM ≥10 kPa and SSM ≤40 kPa, or LSM <10 kPa and SSM >40 kPa) ( p <0.0001). Among the 78 patients undergoing longitudinal evaluation, four of nine patients (44%) with SSM increase during follow-up experienced liver decompensation, whereas none of those with stable LSM and SSM had liver decompensation. Conclusions Both LSM and SSM predict liver decompensation in patients with PBC. SSM ≤40 kPa rules out high-risk oesophageal varices and might be used in combination with LSM to improve the prediction of PH-related complications. Impact and implications Spleen stiffness measurement by vibration-controlled transient elastography accurately predicts portal hypertension in patients with chronic viral hepatitis. The present study is the first to demonstrate that in primary biliary cholangitis the combination of liver stiffness and spleen stiffness measurement can significantly improve risk stratification by predicting liver decompensation. Moreover, when spleen stiffness is combined with liver stiffness measurement and platelet count, it aids in identifying individuals with a low probability of having high-risk oesophageal varices, thereby allowing the avoidance of unnecessary endoscopy examinations. Further validation of our results in larger cohorts of patients with primary biliary cholangitis is needed to implement spleen stiffness measurement in clinical practice.

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  • Spleen stiffness by transient elastography and its combination with liver stiffness can be a promising predictor of primary biliary cholangitis prognosis.

    “Spleen stiffness by transient elastography and its combination with liver stiffness can also be a promising predictor of primary biliary cholangitis prognosis.127”

    From Primary biliary cholangitis. (2024) · cites this paper as [127]

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Authors
Rigamonti, C., Cittone, M. G., Manfredi, G. F., De Benedittis, C., Paggi, N., Baorda, F., Di Benedetto, D., Minisini, R., & Pirisi, M.
Affiliations
Università degli Studi del Piemonte Orientale “Amedeo Avogadro” (IT)
Corresponding author
Rigamonti, Cristina
ORCID
Venue
JHEP Reports
Publisher
Elsevier BV
Published
2024-01
Volume
6
Issue
1
Pages
100952
ISSN
2589-5559 (ISSN-L)
DOI
10.1016/j.jhepr.2023.100952
PMC
PMC10772386
OpenAlex
W4388084538
Cited by
15
References
44
Citations by year
2026: 3 · 2025: 6 · 2024: 6
FWCI
2.54
Type
journal article
Language
en
Open access
Licence
Locations
  • JHEP Reports (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
  • Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
  • Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
Keywords
spleen stiffness, vibration-controlled transient elastography, hepatic decompensation, portal hypertension, esophageal varices, liver stiffness, risk stratification, noninvasive fibrosis assessment, long-term monitoring, liver cirrhosis progression

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