Z Gastroenterol 2019; 57(01): e31
DOI: 10.1055/s-0038-1677122
2. Clinical Hepatology, Surgery, LTX
Georg Thieme Verlag KG Stuttgart · New York

Spleen to liver stiffness ratio significantly differs between ALD and HCV and predicts disease-specific complications

O Elshaarawy
1   1Department of Medicine and Center for Alcohol Research, Salem Medical Center, University of Heidelberg, Germany
,
J Mueller
1   1Department of Medicine and Center for Alcohol Research, Salem Medical Center, University of Heidelberg, Germany
,
IN Guha
2   NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK. 3Nottingham Digestive Diseases Centre, School of Medicine, the University Of Nottingham, Nottingham, UK.
,
J Chalmers
2   NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK. 3Nottingham Digestive Diseases Centre, School of Medicine, the University Of Nottingham, Nottingham, UK.
,
R Harris
2   NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK. 3Nottingham Digestive Diseases Centre, School of Medicine, the University Of Nottingham, Nottingham, UK.
,
M Thiele
3   Department of Gastroenterology and Hepatology and Odense Patient data Exploratory Network, OPEN, Odense University Hospital, Odense, Denmark
,
BS Madsen
3   Department of Gastroenterology and Hepatology and Odense Patient data Exploratory Network, OPEN, Odense University Hospital, Odense, Denmark
,
A Krag
3   Department of Gastroenterology and Hepatology and Odense Patient data Exploratory Network, OPEN, Odense University Hospital, Odense, Denmark
,
H Stefanescu
4   Department of Hepatology, University of Medicine and Pharmacy, Cluj-Napoca, Romania
,
O Stancu
4   Department of Hepatology, University of Medicine and Pharmacy, Cluj-Napoca, Romania
,
S Mueller
1   1Department of Medicine and Center for Alcohol Research, Salem Medical Center, University of Heidelberg, Germany
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Publikationsverlauf

Publikationsdatum:
04. Januar 2019 (online)

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    Background:

    Both liver stiffness (LS) and spleen stiffness (SS) are widely used to non-invasively assess liver fibrosis and portal hypertension, respectively. However, the impact of portal and lobular inflammation (HCV vs. ALD) on SS/LS remains unclear so far.

    Methodology: LS and SS were prospectively assessed in 411 patients with ALD and HCV using Fibroscan (Echosens, Paris). In addition, the effect of treatment intervention (alcohol withdrawal, HCV therapy and TIPSS) was studied in sub-cohorts and liver-related decompensation and death were analyzed in a retrospective cohort of 449 patients.

    Results:

    SS and spleen size were significantly higher in HCV as compared to ALD (42.0 vs. 32.6 kPa, P < 0.0001, 15.6 vs. 11.9 cm, P < 0.0001) despite a lower mean LS in HCV (14.9 vs. 28.5 kPa). Moreover, the SS/LS ratio was significantly higher in HCV (3.8 vs. 1.72, P < 0.0001) and it remained higher in HCV through all fibrosis stages. After treatment, LS significantly decreased in both diseases while SS only significantly declined in HCV. No significant change of LS/SS was observed during treatment. In the prognostic cohort, ALD patients had higher LS values (30.5 vs. 21.3 kPa), predominantly presented for jaundice (65.2%) which was also the major cause of death (P < 0.01). In contrast, in HCV, spleens were larger (17.6 vs. 12.1 cm), the primary sign of decompensation (73.2%) and major cause of death (P < 0.001) was variceal bleeding.

    Conclusion:

    The SS/LS ratio is significantly higher in patients with portal disease such as HCV as compared to lobular disease (ALD) and predicts disease-specific complications and survival such as liver failure in ALD and variceal bleeding in HCV. In conclusion, combined LS and SS measurements provide additional information about disease etiology and potential risk of decompensation.


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