TY - JOUR
T1 - Transient elastography measurements of spleen stiffness as a predictor of clinically significant varices in children
AU - Sutton, Harry
AU - Fitzpatrick, Emer
AU - Davenport, Mark
AU - Burford, Charlotte
AU - Alexander, Emma
AU - Dhawan, Anil
AU - Grammatikopoulos, Tassos
PY - 2018/10
Y1 - 2018/10
N2 - Objectives: Investigate the use of spleen stiffness measurements (SSMs), measured by transient elastography (TE), for the prediction of clinically significant varices (CSV) in children with portal hypertension. Methods: This observational cohort study included children selected for endoscopy, as per department protocol, between September 2015 and June 2016. Those included underwent single TE FibroScan for liver stiffness measurements and SSM. Clinical and laboratory data were collected and variceal prediction scores were calculated at time of elastography. Results: In total 67 children (32 boys) underwent TE. Fifty-two children (25 boys) had chronic liver disease (CLD), 15 (7 boys) portal vein thrombosis (PVT). In all children SSM was the best predictor of CSV+ve, with an optimal cut-off value of 38.0 kPa (area under the receiver operator curve [AUROC]=0.92, sensitivity= 89%, specificity=82%, P<0.01). In the CLD group SSM was also the best predictor, with an optimal cut-off value of 38.05 kPa (AUROC=0.90, sensitivity= 84%, specificity=87%, P< 0.01). In the PVT group only SSM was predictive of CSV+ve, with an optimal cutoff value of 16.8 kPa (AUROC=1.00, sensitivity=100%, specificity = 100%, P<0.001). For the prediction of GI bleeding (n=6), liver stiffness measurement performed the best, with an optimal cut-off value of 34.3 kPa (AUROC=0.84, sensitivity of 80%, specificity of 88%, P = 0.01). Conclusions: SSM was the greatest predictor of CSV+ve in the whole cohort, and individual CLD and PVT groups. SSM could be used as a noninvasive screening tool for children with portal hypertension to stratify the risk of having CSV.
AB - Objectives: Investigate the use of spleen stiffness measurements (SSMs), measured by transient elastography (TE), for the prediction of clinically significant varices (CSV) in children with portal hypertension. Methods: This observational cohort study included children selected for endoscopy, as per department protocol, between September 2015 and June 2016. Those included underwent single TE FibroScan for liver stiffness measurements and SSM. Clinical and laboratory data were collected and variceal prediction scores were calculated at time of elastography. Results: In total 67 children (32 boys) underwent TE. Fifty-two children (25 boys) had chronic liver disease (CLD), 15 (7 boys) portal vein thrombosis (PVT). In all children SSM was the best predictor of CSV+ve, with an optimal cut-off value of 38.0 kPa (area under the receiver operator curve [AUROC]=0.92, sensitivity= 89%, specificity=82%, P<0.01). In the CLD group SSM was also the best predictor, with an optimal cut-off value of 38.05 kPa (AUROC=0.90, sensitivity= 84%, specificity=87%, P< 0.01). In the PVT group only SSM was predictive of CSV+ve, with an optimal cutoff value of 16.8 kPa (AUROC=1.00, sensitivity=100%, specificity = 100%, P<0.001). For the prediction of GI bleeding (n=6), liver stiffness measurement performed the best, with an optimal cut-off value of 34.3 kPa (AUROC=0.84, sensitivity of 80%, specificity of 88%, P = 0.01). Conclusions: SSM was the greatest predictor of CSV+ve in the whole cohort, and individual CLD and PVT groups. SSM could be used as a noninvasive screening tool for children with portal hypertension to stratify the risk of having CSV.
KW - Clinically significant varices
KW - Portal hypertension
KW - Spleen stiffness
KW - Transient elastography
UR - http://www.scopus.com/inward/record.url?scp=85064249754&partnerID=8YFLogxK
U2 - 10.1097/MPG.0000000000002069
DO - 10.1097/MPG.0000000000002069
M3 - Article
C2 - 30234702
VL - 67
SP - 446
EP - 451
JO - Journal of Pediatric Gastroenterology and Nutrition
JF - Journal of Pediatric Gastroenterology and Nutrition
IS - 4
ER -