Original scientific paper
https://doi.org/10.3325/cmj.2015.56.470
Real-time two-dimensional shear wave ultrasound elastography of the liver is a reliable predictor of clinical outcomes and the presence of esophageal varices in patients with compensated liver cirrhosis
Ivica Grgurević
orcid.org/0000-0003-0520-3483
; Department of Gastroenterology University Hospital Dubrava University of Zagreb School of Medicine and Faculty of Pharmacy and Biochemistry, Zagreb, Croatia
Tomislav Bokun
; Department of Gastroenterology University Hospital Dubrava University of Zagreb School of Medicine and Faculty of Pharmacy and Biochemistry, Zagreb, Croatia
Sanda Mustapić
; Department of Gastroenterology University Hospital Dubrava University of Zagreb School of Medicine and Faculty of Pharmacy and Biochemistry, Zagreb, Croatia
Vladimir Trkulja
; Department of Pharmacology, University of Zagreb School of Medicine, Zagreb, Croatia
Renata Heinzl
; Department of Pathology and Cytology, University Hospital Dubrava, Zagreb, Croatia
Marko Banić
; Department of Gastroenterology University Hospital Dubrava University of Zagreb School of Medicine and Faculty of Pharmacy and Biochemistry, Zagreb, Croatia
Željko Puljiz
; Department of Gastroenterology University Hospital Center Split, University of Split School of Medicine, Split, Croatia
Boris Lukšić
; Department of Infectious Diseases, University Hospital Center Split, University of Split School of Medicine, Split, Croatia
Milan Kujundžić
; Department of Gastroenterology University Hospital Dubrava University of Zagreb School of Medicine and Faculty of Pharmacy and Biochemistry, Zagreb, Croatia
Abstract
Aim Primary: to evaluate predictivity of liver stiffness (LS),
spleen stiffness (SS), and their ratio assessed by real-time 2D
shear wave elastography (RT-2D-SWE) for adverse outcomes
(hepatic decompensation, hepatocellular carcinoma or
death; “event”) in compensated liver cirrhosis (LC) patients.
Secondary: to evaluate ability of these measures to discriminate
between cirrhotic patients with/without esophageal
varices (EV).
Methods Predictivity of LS, SS, and LS/SS was assessed in a
retrospectively analyzed cohort of compensated LC patients
(follow-up cohort) and through comparison with incident
patients with decompensated cirrhosis (DC) (cross-sectional
cohort). Both cohorts were used to evaluate diagnostic
properties regarding EV.
Results In the follow-up cohort (n = 44) 18 patients (40.9%)
experienced an “event” over a median period of 28 months.
LS≥21.5 kPa at baseline was independently associated with
3.4-fold (95% confidence interval [CI] 1.16-10.4, P = 0.026)
higher risk of event. Association between SS and outcomes
was weaker (P = 0.056), while there was no association between
LS/SS ratio and outcomes. Patients with DC (n = 43)
had higher LS (35.3 vs 18.3 kPa, adjusted difference 65%,
95% CI 43%-90%; P < 0.001) than compensated patients
at baseline. Adjusted odds of EV increased by 13% (95% CI
7.0%-20.0%; P < 0.001) with 1 kPa increase in LS. At cut-offs
of 19.7 and 30.3 kPa, LS and SS had 90% and 86.6% negative
predictive value, respectively, to exclude EV in compensated
patients.
Conclusion This is the first evaluation of RT-2D-SWE as a
prognostic tool in LC. Although preliminary and gathered in
a limited sample, our data emphasize the potential of LS to
be a reliable predictor of clinical outcomes and the presence
of EV in LC patients.
Keywords
Hrčak ID:
151744
URI
Publication date:
15.10.2015.
Visits: 1.489 *