Spleen volume as a non-invasive predictor of complicated portal hypertension: clinical significance and diagnostic potential
DOI:
https://doi.org/10.15574/PS.2025.2(87).4451Keywords:
splenomegaly, portal hypertension, prediction, gastroesophageal varices, spleen volume, non-invasive diagnosticsAbstract
Portal hypertension (PH) is a common complication of liver cirrhosis, leading to the development of esophageal and gastric varices (GOV), ascites, and hypersplenism. One of the most prevalent manifestations of complicated portal hypertension (CPH) is splenomegaly (SMG), observed in 80-90% of patients. Spleen volume (SV) is considered an integrated marker of splanchnic hemodynamics and a potential predictor of the severity of PH.
Aim - to investigate the prevalence of SMG in patients with diagnosed CPH and to evaluate its predictive value for the presence of GOV.
Materials and methods. A total of 187 patients with acquired chronic liver disease (ACLD) (fibrosis or cirrhosis) and clinically significant portal hypertension (CSPH) with confirmed grade II-III GOV were included, along with 46 healthy controls (CG). SV was measured by ultrasound B-mode by determining three linear dimensions and using automated calculation. The Child-Pugh score was used to assess liver functional status. For evaluating the prediction model parameters of GOV, ROC analysis with calculation of AUC was applied.
Results. SMG (SV >314 cm3) was detected in 98% of patients with GOV and in none of the CG. The mean SV in the study group was 5.8 times higher than in CG (853.3±404.3 vs.146±56.9 cm3), with median values of 765 cm3 and 140 cm3, respectively (p<0.0001). The area under the ROC curve (AUC) for SV as a predictor of GOV was 0.995, with a sensitivity of 98.9% and specificity of 100% at the cut-off point of 293 cm3.
Conclusions. The high prognostic value of SV as an independent predictor of the presence of GOV in patients with ACLD and CPH has been confirmed. No association between SV and the degree of the liver dysfunction was established.
The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee for all participants. Informed consent was obtained from patients.
The authors declare no conflict of interest.
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