Abstract
ObjectivesTo systematically review studies on the diagnostic accuracy of spleen stiffness measurement (SSM) for the detection of clinical significant portal hypertension (CSPH), severe portal hypertension (SPH), esophageal varices (EV), and high-risk esophageal varices (HREV) in patients with chronic liver diseases (CLD).MethodsThrough a systematic search, we identified 32 studies reporting the accuracy of SSM for the diagnosis of portal hypertension (PH) and/or EV in adults with CLD. A bivariate random-effects model was performed to estimate pooled sensitivity, specificity, likelihood ratio, positive predictive value (PPV), negative predictive value (NPV), and diagnostic odds ratios (DOR). The clinical utility of SSM was evaluated by Fagan plot.ResultsA total of 32 studies assessing 3952 patients were included in this meta-analysis. The pooled sensitivities of SSM were 0.85 (95% confidence interval (CI), 0.69–0.93) for CSPH; 0.84 (95% CI, 0.75–0.90) for SPH; 0.90 (95% CI, 0.83–0.94) for any EV; and 0.87 (95% CI, 0.77–0.93) for HREV. The pooled specificities of SSM were 0.86 (95% CI, 0.74–0.93) for CSPH; 0.84 (95% CI, 0.72–0.91) for SPH; 0.73 (95% CI, 0.66–0.79) for EV; and 0.66 (95% CI, 0.53–0.77) for HREV. Summary PPV and NPV of SSM for detecting HREV were 0.54 (95% CI, 0.47–0.62) and 0.88 (95% CI, 0.81–0.95), respectively.ConclusionsOur meta-analysis suggests that SSM could be used as a helpful surveillance tool in management of CLD patients and was quite useful for ruling out the presence of HREV thereby avoiding unnecessary endoscopy.Key Points• SSM could be used to rule out the presence of HREV in patients with CLD thereby avoiding unnecessary endoscopy.• SSM has significant diagnostic value for CSPH and SPH with high sensitivity and specificity in patients with CLD.• SSM could be used as a helpful surveillance tool for clinicians managing CLD patients.
Highlights
Portal hypertension (PH) is a set of clinical syndromes caused by increased pressure in the portal venous system and is one of the primary consequences of chronic liver diseases (CLD), which can lead to the formation of extensive collateral circulation [1]
36 articles were excluded after full-text review for the following reasons: undesirable article types, not diagnostic accuracy study, not relevant to CLD, small sample size, insufficient data (TP, false positive (FP), true negative (TN), and false negative (FN) not reported or could not be calculated), and not in English
No of Sensitivity Specificity positive predictive value (PPV). The results of this meta-analysis indicated that spleen stiffness measured by current techniques had a fairly good accuracy for the detection of PH and esophageal varices (EV) in CLD patients
Summary
Portal hypertension (PH) is a set of clinical syndromes caused by increased pressure in the portal venous system and is one of the primary consequences of chronic liver diseases (CLD), which can lead to the formation of extensive collateral circulation [1]. Clinical significant portal hypertension (CSPH) is defined as hepatic venous pressure gradient (HVPG) ≥ 10 mmHg, which could result in clinical complications of PH such as esophageal varices (EV), ascites, hepatic encephalopathy, and hepatorenal syndrome. Severe portal hypertension (SPH) defined as HVPG ≥ 12 mmHg is a risk factor of variceal bleeding [2]. EV is the most important collateral circulation of PH and occurs in approximately 50% of cirrhotic patients, while variceal bleeding is associated with high mortality [3, 4]. Measurement of the HVPG and EGD are invasive and potentially associated with complications, the application of the two types of detection methods is limited due to poor patient compliance [7]. Alternative noninvasive techniques, with favorable diagnostic performance for evaluating PH and EV would be extremely attractive
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