Combination measurement of liver and spleen stiffness with portal vein width to evaluate risk of bleeding in esophageal and gastric varices patients

Abstract

To evaluate the utility of combined liver stiffness measurement (LSM) and spleen stiffness measurement (SSM), by transient elastography, along with measurement of portal vein width (PVW) for evaluating risk of bleeding in patients with esophageal and gastric varices (EV). A total of 73 patients with cirrhosis who were treated in the Department of Gastroenterology of the Second Affiliated Hospital of Xi'an Jiaotong University between April 2014 and March 2015 were included in the study. Child-Pugh classifications were obtained, portal vein widths were measured by ultrasound, liver and spleen stiffness were measured by transient elastography using FibroTouch®. Patients were examined by electronic endoscopy, upper abdominal computed tomography and standard serum testing. The serum indexes of fibrosis (aspartate aminotransferase (AST) to platelet ratio index (APRI), and AST to alanine aminotransferase ratio (AAR)) were calculated. Patients were grouped according to the results of gastroscopy, with severe (EV) and high risk of bleeding comprising group A and no or mild-to-moderate EV and low risk of bleeding comprising group B. Statistical analysis was carried out with t-test for continuous variables and χ(2) test for categorical variables to first screen out variables different between groups then the correlation with severe EV was assessed by generating receiver operating characteristic (ROC) curves. Lastly, binary logistic regression was used to evaluate the performance of combined variables for diagnosing severe EV and their predictive value for risk of bleeding. Group A and B showed significant differences for LSM, SSM and PVW (all P < 0.05). The cutoff values for diagnosing severe EV were 23.4 kPa for LSM, 40.3 kPa for SSM and 11.5 mm for PVW, with areas under the ROC curve (AUROC) as 0.655, 0.788 and 0.709 respectively. For combined measurements, the AUROC was 0.773 for LSM plus PVW and 0.840 for LSM plus PVW (with highest diagnostic performance). Combination of SSM plus PVW measurement shows high diagnostic performance for evaluating severe EV, and better performance than LSM plus SSM plus PVW and LSM plus PVW, with good predictive value for risk of EV bleeding.