Validation of Spleen Stiffness Measurement for Screening of High-risk Esophageal Varices Among Cirrhotic Patients in Indonesia: A Single-Center Cross-sectional Study

Authors

  • Saut Horas Hatoguan Nababan Hepatobiliary Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Gita Aprilicia Hepatobiliary Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Pitt Akbar Hepatobiliary Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Kemal Fariz Kalista Hepatobiliary Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Chyntia Olivia Maurine Jasirwan Hepatobiliary Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Juferdy Kurniawan Hepatobiliary Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Cosmas Rinaldi A. Lesmana Hepatobiliary Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Andri Sanityoso Sulaiman Hepatobiliary Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Irsan Hasan Hepatobiliary Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Rino Alvani Gani Hepatobiliary Division, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia

Keywords:

spleen stiffness, esophageal varices, cirrhosis, Indonesia, validation

Abstract

Background: Spleen stiffness measurement (SSM) is a recently developed non-invasive method for predicting clinically significant portal hypertension and esophageal varices in compensated advanced liver disease or cirrhosis. This study aims to validate the accuracy of SSM for screening high-risk esophageal varices among cirrhotic patients in Indonesia. Methods: This is a single-center, cross-sectional study. Patients with liver cirrhosis who underwent endoscopy at Cipto Mangunkusumo Hospital, Jakarta were included. Clinical data and data from laboratory tests, endoscopy, liver, and spleen stiffness measurement by transient elastography (TE) were collected. A 100 Hz spleen-dedicated TE probe was used for SSM. Results: Of 86 patients, 52 had high-risk esophageal varices. The median (IQR) value of SSM were significantly higher in patients with high-risk varices [36.1 kPa (IQR 21.5-59.1) vs. 70.3 kPa (IQR (52.2-86.0); p<0.001). SSM with a low cutoff value of 20 kPa had sensitivity and negative predictive value of 98.1% and 87.5%, respectively. The high cutoff value of 70 kPa had specificity and positive predictive value of 82.4% and 81.3%, respectively. Conclusion: SSM is useful for screening high-risk esophageal varices. Furthermore, the new dual cutoff value can help rule-in and rule-out high-risk esophageal varices among cirrhotic patients in Indonesia.

References

Agustina R, Dartanto T, Sitompul R, et al. On behalf of the Indonesia Health Systems Group. Universal health coverage in Indonesia: concept, progress, and challenges. Lancet. 2019;393(10166):75–102.

Kalista KF, Lesmana CRA, Sulaiman AS, et al. Profil klinis pasien sirosis hati dengan varises esofagus yang menjalani ligasi varises esofagus di Rumah Sakit Dr. Cipto Mangunkusumo. JPDI. 2019;6(1):36.

Younossi ZM, Wong G, Anstee QM, et al. The global burden of liver disease. Clin Gastroenterol Hepatol. 2023;S1542-3565(23)00315-4.

Tapper EB, Parikh ND. Diagnosis and management of cirrhosis and its complications: A review. JAMA. 2023;329(18):1589-602.

de Franchis R, Bosch J, Garcia-Tsao G, et al. Baveno VII faculty. Baveno VII - Renewing consensus in portal hypertension. J Hepatol. 2022;76(4):959-74.

Chen Y, Wang W, Wang H, et al. Rapamycin attenuates splenomegaly in both intrahepatic and prehepatic portal hypertensive rats by blocking mTOR signaling pathway. PLoS One. 2016;11(1):e0141159.

Hu X, Huang X, Hou J, et al. Diagnostic accuracy of spleen stiffness to evaluate portal hypertension and esophageal varices in chronic liver disease: a systematic review and meta-analysis. Eur Radiol. 2021;31(4):2392-404.

Rigamonti C, Cittone MG, Manfredi GF, et al. High reproducibility of spleen stiffness measurement by vibration-controlled transient elastography with a spleen-dedicated module. Hepatol Commun. 2022;6(11):3006-14.

Shiina T, Nightingale K.R, Palmeri ML, et al. WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 1: Basic principles and terminology. Ultrasound Med. Biol. 2015;41:1126–47.

Segna D, Mendoza YP, Lange NF, et al. Non-invasive tools for compensated advanced chronic liver disease and portal hypertension after Baveno VII - an update. Dig Liver Dis. 2023;55(3):326-35.

Wong GL, Liang LY, Kwok R, et al. Low risk of variceal bleeding in patients with cirrhosis after variceal screening stratified by liver/spleen stiffness. Hepatology. 2019 Sep;70(3):971-81.

Bai W, Abraldes JG. Noninvasive assessment oesophageal varices: impact of the Baveno VI criteria. Curr Opin Gastroenterol 2022;38(3):206–15.

Siahaan BS, Kurniawan J, Simadibrata M, et al. Performance of spleen stiffness, liver stiffness and their combination for predicting esophageal varices among patient with hepatitis B virus-related cirrhosis. The Indonesian Journal of Gastroenterology Hepatology and Digestive Endoscopy. 2023; 24(2):137-42.

Quek J, Chan KE, Wong ZY, et al. Global prevalence of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in the overweight and obese population: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2023;8(1):20-30.

Downloads

Published

2024-10-25

How to Cite

Nababan, S. H. H., Aprilicia, G., Akbar, P., Kalista, K. F., Jasirwan, C. O. M., Kurniawan, J., Lesmana, C. R. A., Sulaiman, A. S., Hasan, I., & Gani, R. A. (2024). Validation of Spleen Stiffness Measurement for Screening of High-risk Esophageal Varices Among Cirrhotic Patients in Indonesia: A Single-Center Cross-sectional Study. Acta Medica Indonesiana, 56(3), 276. Retrieved from https://actamedindones.org/index.php/ijim/article/view/2450

Issue

Vol. 56 No. 3 (2024): Acta Medica Indonesiana

Section

ORIGINAL ARTICLE

License

Copyright

The authors who publish in this journal agree to the following requirements:

  1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a  Creative Commons Attribution 4.0 International License (CC BY 4.0) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
  2. Authors can enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
  3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) before and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. (See The Effect of Open Access)

Privacy Statement

The names and email addresses entered in this journal site will be used exclusively for the stated purposes of this journal and will not be made available for any other purpose or to any other party.