P1223 - Utility of Ultrasonographic Two‑Dimensional Measurement of Spleen in the Assessment of Clinically Significant Portal Hypertension by Comparing Several Non-invasive Fibrosis Tests (NIFTs) or Models

Sunday, October 27, 2024

3:30 PM – 7:00 PM ET

Location: Exhibit Hall E

Has Audio

Presenting Author(s)

KH

Ke-Qin Hu, MD

University of California, Irvine
Orange, CA

Hien Lau, MD, Jason Samarasena, MD, Ke-Qin Hu, MD
University of California, Irvine, Orange, CA

Introduction: Ultrasonographic spleen two-dimensional measurement (2D, i.e, length x thickness) > 46 cm² has been shown excellent sensitivity and specificity in diagnosing cirrhosis. However, its performance in evaluating clinically significant portal hypertension (CSPH) is unknown. This study assessed the performance of spleen 2D and its association with CSPH and other NIFTs or models for advanced fibrosis, i.e., F3-4.

Methods: A single-center retrospective study on 488 patients followed at the UCIMC Liver Clinic for various chronic liver diseases (CLDs) with spleen 2D measurements via ultrasonography (US), liver biopsy (LBx), endoscopic ultrasound guided portal pressure gradient (EUS-PPG) and other NIFTs.

Results: The mean age was 56 ± 14; 50%, male; 30.2% had a BMI ≥ 30; 19.2%, 19.6%, and 28.6%, chronic hepatitis C, B, and metabolic dysfunction-associated steatotic liver disease (MASLD), respectively. Using EUS-PPG ≥ 10 mmHg for CSPH, the sensitivity, specificity, PPV and NPV of spleen 2D > 46 cm² was 96.2%, 48.2%, 37.3% and 97.5%, respectively. In 52.1% with spleen 2D > 46 cm² (vs. ≤ 46 cm²), it was significantly associated with male gender (60.2% vs. 39.1%, p< .01), Caucasian ethnicity (48.0% vs. 25.8%, p< .01), BMI ≥ 30 (40.9% vs. 18.5%, p< .01), diabetes mellitus (42.1% vs. 31.9%, p=.02), MASLD as the primary CLD (35.0% vs. 24.0%, p< .01), cirrhosis (59.1% vs. 33.0%, p< .01), hepatic decompensation (32.5% vs. 7.7%, p< .01), especially by ascites (26.4% vs. 9.0%, p< .01), hepatic encephalopathy (10.2% vs. 1.7%, p< .01), and variceal bleeding (6.2% vs. .9%, p< .01). Spleen 2D > 46 cm² was significantly associated with LBx F3-4 (44.6% vs. 30.8%, p< .01), F3-4 by shear wave elastography (SWE, 59.5% vs. 38.7%, p< .01), hepatic nodular contour on US (48.0% vs. 20.2%, p< .01), EUS-PPG ≥ 10 mmHg (37.3% vs. 2.5%, p< .01). Spleen 2D > 46 cm² was also associated with MELD ≥ 10 (43.3% vs. 23.3%, p< .01), Child > 6 (43.0% vs. 30.8%, p< .01), APRI > 1 (35.4% vs. 25.1%, p=.02), FIB-4 > 2.67 (43.3% vs. 32.3%, p=.02). Multivariate analysis showed that spleen 2D > 46 cm² was significantly associated with EUS-PPG ≥ 10 mmHg (95% CI 2.4-185.9, p< .001), independent to LBx F3-4, F3-4 by SWE, MELD ≥ 10, Child > 6, FIB-4 > 2.67, APRI > 1.

Discussion: Spleen 2D > 46 cm² has good sensitivity and NPV in assessing CSPH and is significantly associated with EUS-PPG ≥ 10 mmHg, independent of F3-4 by LBx and SWE and several other NIFTs, and thus, should be considered as a non-invasive screening test for CSPH in various CLDs.

Disclosures:

Hien Lau indicated no relevant financial relationships.

Jason Samarasena: Cook Medical – Consultant. Medtronic – Advisory Committee/Board Member, Consultant. Neptune Medical – Advisory Committee/Board Member, Consultant. Olympus – Advisory Committee/Board Member, Consultant. Ovesco – Advisory Committee/Board Member, Consultant, Speakers Bureau. SatisfAI – Stock-privately held company. Steris – Advisory Committee/Board Member.

Ke-Qin Hu: Medrigal – Speakers Bureau.

Hien Lau, MD, Jason Samarasena, MD, Ke-Qin Hu, MD. P1223 - Utility of Ultrasonographic Two‑Dimensional Measurement of Spleen in the Assessment of Clinically Significant Portal Hypertension by Comparing Several Non-invasive Fibrosis Tests (NIFTs) or Models, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.