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

• Published in: Acta medica Indonesiana Vol. 56; no. 3; p. 276
• Main Authors: Nababan, Saut Horas Hatoguan, Aprilicia, Gita, Akbar, Pitt, Kalista, Kemal Fariz, Jasirwan, Chyntia Olivia Maurine, Kurniawan, Juferdy, Lesmana, Cosmas Rinaldi A, Sulaiman, Andri Sanityoso, Hasan, Irsan, Gani, Rino Alvani
• Format: Journal Article
• Language: English
• Published: Indonesia 01.07.2024
• Subjects: Adult; Aged; Cross-Sectional Studies; Elasticity Imaging Techniques; Esophageal and Gastric Varices - diagnosis; Esophageal and Gastric Varices - etiology; Female; Humans; Hypertension, Portal - complications; Hypertension, Portal - diagnosis; Indonesia - epidemiology; Liver Cirrhosis - complications; Male; Middle Aged; Predictive Value of Tests; Sensitivity and Specificity; Spleen - diagnostic imaging; Indonesia; spleen stiffness; esophageal varices; cirrhosis; validation; Indonesia
• ISSN: 0125-9326

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. 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. 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. 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.