Spleen Stiffness Is Superior to Liver Stiffness for Predicting Esophageal Varices in Chronic Liver Disease: A Meta-Analysis

Xiaowen Ma, Le Wang, Hao Wu, Yuemin Feng, Xibiao Han, Haoran Bu, Qiang Zhu, Xiaowen Ma, Le Wang, Hao Wu, Yuemin Feng, Xibiao Han, Haoran Bu, Qiang Zhu

Abstract

Background and aims: Liver stiffness (LS) and spleen stiffness (SS) are two most widely accessible non-invasive parameters for predicting esophageal varices (EV), but the reported accuracy of the two predictors have been inconsistent across studies. This meta-analysis aims to evaluate the diagnostic performance of LS and SS measurement for detecting EV in patients with chronic liver disease (CLD), and compare their accuracy.

Methods: Pubmed/Medline, Embase, Cochrane Library and Ovid were searched for all studies assessing SS and LS simultaneously in EV diagnosis. A total of 16 studies including 1892 patients were included in this meta-analysis, and the pooled statistical parameters were calculated using the bivariate mixed effects models.

Results: In detection of any EV, for LS measurement, the summary sensitivity was 0.83 (95% confidence interval [CI]: 0.78-0.87), and the specificity was 0.66 (95% CI: 0.60-0.72). While for SS measurement, the pooled sensitivity and specificity was 0.88 (95% CI: 0.83-0.92) and 0.78 (95% CI: 0.73-0.83). The summary receiver operating characteristic (SROC) curve values of LS and SS were 0.81 (95% CI: 0.77-0.84) and 0.88 (95% CI: 0.85-0.91) respectively, and the results had statistical significance (P<0.01). The diagnostic odds ratio (DOR) of SS (25.73) was significantly higher than that of LS (9.54), with the relative DOR value was 2.48 (95%CI: 1.10-5.60), P<0.05.

Conclusions: Under current techniques, SS is significantly superior to LS for identifying the presence of EV in patients with CLD. SS measurement may help to select patients for endoscopic screening.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Flow diagram showing study identification…
Fig 1. Flow diagram showing study identification and selection.
LS, liver stiffness; SS, spleen stiffness; PH, portal hypertension; EV, esophageal varices; EGD, esophagogastroduodenoscopy; TIPS, transjugular intrahepatic portosystemic shunt.
Fig 2. Forest plot of individual study…
Fig 2. Forest plot of individual study evaluates of sensitivity and specificity for any esophageal varices diagnosis.
The base vertical imaginary line indicates the combined effects. (A) Accuracy of liver stiffness measurement for estimating the presence of esophageal varices. (B) Accuracy of spleen stiffness for detecting the presence of any esophageal varices in chronic liver disease.
Fig 3. Summary receiver operating characteristic (SROC)…
Fig 3. Summary receiver operating characteristic (SROC) curve of sensitivity versus specificity.
(A) SROC curve of liver stiffness for prediction of any esophageal varices. (B) SROC curve of spleen stiffness for detecting the presence of esophageal varices.
Fig 4. Fagan plot analysis to evaluating…
Fig 4. Fagan plot analysis to evaluating the clinical utility of liver and spleen stiffness for diagnosis of esophageal varices.
(A) For LS measurements, with a pre-test probability of EV of 57%, the post-test probability of EV, given negative and positive results, were 25% and 76%. (B) For SS measurements, with a pre-test probability of EV of 57%, the post-test probability of EV, given negative and positive results, were 17% and 84%.

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