The accuracy of spleen stiffness measurement to predict varices in chronic hepatitis B cirrhotic patients with or without taking non-selective beta-blockers

ABSTRACT

Background & Aims

The accuracy of liver and spleen stiffness measurement (LSM & SSM) with transient elastography to predict varices in the presence of non-selective beta-blockers (NSBB) has never been studied before.

Methods

This was a cross-sectional study of consecutive patients with chronic hepatitis B (CHB) and cirrhosis. All patients underwent transient elastography and upper endoscopic examinations. Performance of LSM and SSM to predict varices in patients did and did not receive NSBB was evaluated.

Results

144 CHB patients (29 received NSBB; 35 had any varices, 31 and 11 had esophageal and gastric varices respectively) were recruited. The mean LSM and SSM were 19.7 ± 10.1 kPa and 24.8 ± 7.2 kPa respectively. The correlation between LSM and SSM was better in NSBB subgroup (r = 0.525, P = 0.003) than its counterpart (r = 0.329, P < 0.001). Area under receiver operating characteristic curve (AUC) of LSM and SSM for any varices was 0.675 and 0.685 respectively (P = 0.002 and 0.001 respectively). A SSM of 19.7 kPa had a sensitivity of 91.4% and negative likelihood ratio 0.24 to rule out any varices; that of 54.9 kPa had a specificity of 91.8% and positive likelihood ratio 4.53 respectively to rule in varices. AUC of LSM for any varices was 0.742 and 0.549 respectively in patients with or without receiving NSBB; the corresponding AUC of SSM was 0.572 and 0.603 respectively.

Conclusion

SSM may be considered as the first line non-invasive tool in the surveillance strategy for varices in patients with or without taking NSBB.

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