Age, Sex, and Body Mass Index Should Be Considered When Assessing Spleen Length in Patients with Compensated Advanced Chronic Liver Disease
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Background/Aims: We investigated the factors related to spleen length and the diagnostic accuracy of a model using spleen length corrected by related factors, for the prediction of varices needing treatment (VNT). Methods: Various prediction models for VNT including spleen length were analyzed in the cohort of compensated advanced chronic liver disease (cACLD), defined as liver stiffness (LS) ≥10 kPa in a recent study. The associated factors for spleen length were identified in healthy subjects to improve the prediction of VNT. Results: Among 1,218 cACLD patients, VNT was noted in 249 patients (20.4%). On multivariate analysis, longer spleen length, lower platelet count, and higher LS value were independent predictors for VNT (all p<0.001). In multivariate analysis of 1,041 healthy subjects, age (β=–0.027), sex (β=0.762), and body mass index (β=0.097) were found to be significant factors for spleen length (all p<0.001). Using the β values, the estimated spleen length was calculated. To improve the prediction of VNT, the ratio of measured and estimated spleen length was calculated. Based on binary regression analysis results, the LS value-spleen ratio to platelet score (LSRPS) was calculated as follows: 0.027×LS value (kPa)+2.690×measured/estimated spleen ratio–0.011×platelet count (cells×109/L)–4.215. The area under the receiver operating characteristic of the LSRPS for VNT was 0.820, which was significantly higher than 0.797 of LS value-spleen diameter to platelet ratio score (LSPS) (p=0.006). Conclusions: Spleen length is influenced by age, sex, and body mass index in the Asian population. The LSRPS using the measured/estimated spleen ratio had higher diagnostic accuracy than LSPS in predicting VNT in patients with cACLD.
Abstract
Background/Aims: We investigated the factors related to spleen length and the diagnostic accuracy of a model using spleen length corrected by related factors, for the prediction of varices needing treatment (VNT). Methods: Various prediction models for VNT including spleen length were analyzed in the cohort of compensated advanced chronic liver disease (cACLD), defined as liver stiffness (LS) ≥10 kPa in a recent study. The associated factors for spleen length were identified in healthy subjects to improve the prediction of VNT. Results: Among 1,218 cACLD patients, VNT was noted in 249 patients (20.4%). On multivariate analysis, longer spleen length, lower platelet count, and higher LS value were independent predictors for VNT (all p<0.001). In multivariate analysis of 1,041 healthy subjects, age (β=–0.027), sex (β=0.762), and body mass index (β=0.097) were found to be significant factors for spleen length (all p<0.001). Using the β values, the estimated spleen length was calculated. To improve the prediction of VNT, the ratio of measured and estimated spleen length was calculated. Based on binary regression analysis results, the LS value-spleen ratio to platelet score (LSRPS) was calculated as follows: 0.027×LS value (kPa)+2.690×measured/estimated spleen ratio–0.011×platelet count (cells×109/L)–4.215. The area under the receiver operating characteristic of the LSRPS for VNT was 0.820, which was significantly higher than 0.797 of LS value-spleen diameter to platelet ratio score (LSPS) (p=0.006). Conclusions: Spleen length is influenced by age, sex, and body mass index in the Asian population. The LSRPS using the measured/estimated spleen ratio had higher diagnostic accuracy than LSPS in predicting VNT in patients with cACLD.
참고문헌 (28)
- Bolognesi M, "Role of spleen enlargement in cirrhosis with portal hypertension", Dig Liver Dis, 34, pp.144~150 (2002)
- Merkel C, "Splenic haemodynamics and portal hypertension in patients with liver cirrhosis and spleen enlargement", Clin Physiol, 5, pp.531~539 (1985)
- Dănilă M, "The ultrasound examination of the spleen", Med Ultrason, 12, pp.253~254 (2010)
- Stiff PJ, "Clinical and ultrasonic evaluation of spleen size during peripheral blood progenitor cell mobilization by filgrastim : results of an openlabel trial in normal donors", Biol Blood Marrow Transplant, 15, pp.827~834 (2009)
- Gibson PR, "Splenomegaly : an insensitive sign of portal hypertension", Aust N Z J Med, 20, pp.771~774 (1990)
- Chow KU, "Spleen size is significantly influenced by body height and sex : establishment of normal values for spleen size at US with a cohort of 1200 healthy individuals", Radiology, 279, pp.306~313 (2016)
- Kaneko J, "Spleen size of live donors for liver transplantation", Surg Radiol Anat, 30, pp.515~518 (2008)
- Albayrak E, "The relationship of spleen stiffness value measured by shear wave elastography with age, gender, and spleen size in healthy volunteers", J Med Ultrason(2001), 46, pp.195~199 (2019)
- Kim BK, "A liver stiffness measurement-based, noninvasive prediction model for high-risk esophageal varices in B-viral liver cirrhosis", Am J Gastroenterol, 105, pp.1382~1390 (2010)
- Abraldes JG, "Noninvasive tools and risk of clinically significant portal hypertension and varices in compensated cirrhosis : the"Anticipate"study", Hepatology, 64, pp.2173~2184 (2016)
- European Association for the Study of the Liver, "EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis", J Hepatol, 69, pp.406~460 (2018)
- Garcia-Tsao G, "Portal hypertensive bleeding in cirrhosis : risk stratification, diagnosis, and management : 2016 practice guidance by the American Association for the study of liver diseases", Hepatology, 65, pp.310~335 (2017)
- The Korean Association for the Study of the Liver, "KASL clinical practice guidelines for liver cirrhosis: Varices, hepatic encephalopathy, and related complications", Clinical and Molecular Hepatology, 26(2), pp.83~127 (2020), 대한간학회[DOI]
- de Franchis R, "Expanding consensus in portal hypertension : report of the Baveno VI Consensus Workshop : stratifying risk and individualizing care for portal hypertension", J Hepatol, 63, pp.743~752 (2015)
- Lee HA, "Prediction of the varices needing treatment with non-invasive tests in patients with compensated advanced chronic liver disease", Liver Int, 39, pp.1071~1079 (2019)
- Cosmas Rinaldi Adithya Lesmana, "Managing liver cirrhotic complications: Overview of esophageal and gastric varices", Clinical and Molecular Hepatology, 26(4), pp.444~460 (2020), 대한간학회
- Augustin S, "Expanding the Baveno VI criteria for the screening of varices in patients with compensated advanced chronic liver disease", Hepatology, 66, pp.1980~1988 (2017)
- Spielmann AL, "Sonographic evaluation of spleen size in tall healthy athletes", AJR Am J Roentgenol, 184, pp.45~49 (2005)
- McCorkle R, "Normative spleen size in tall healthy athletes : implications for safe return to contact sports after infectious mononucleosis", Clin J Sport Med, 20, pp.413~415 (2010)
- Hosey RG, "Ultrasound assessment of spleen size in collegiate athletes", Br J Sports Med, 40, pp.251~254 (2006)
- Yeon Seok Seo, "Prevention and management of gastroesophageal varices", Clinical and Molecular Hepatology, 24(1), pp.20~42 (2018), 대한간학회
- Beppu K, "Prediction of variceal hemorrhage by esophageal endoscopy", Gastrointest Endosc, 27, pp.213~218 (1981)
- Geraghty EM, "Normal organ volume assessment from abdominal CT", Abdom Imaging, 29, pp.482~490 (2004)
- Loftus WK, "Normal splenic size in a Chinese population", J Ultrasound Med, 16, pp.345~347 (1997)
- Rodrigues CJ, "Age-related changes in the elastic fiber network of the human splenic capsule", Lymphology, 32, pp.64~69 (1999)
- Niederau C, "Sonographic measurements of the normal liver, spleen, pancreas, and portal vein", Radiology, 149, pp.537~540 (1983)
- Meier JM, "Assessment of age-related changes in abdominal organ structure and function with computed tomography and positron emission tomography", Semin Nucl Med, 37, pp.154~172 (2007)
- Schranz T, "A comparison of spleen size measured by ultrasound in a random population sample and a matched sample of patients at a university hospital, and the determination of normal values and influencing factors", Z Gastroenterol, 59, pp.438~445 (2021)