Predictive value of liver and spleen stiffness in advanced alcoholic cirrhosis with refractory ascites

Abstract

Background Recurrent ascitic decompensation is a frequent complication of advanced alcoholic liver disease. Ascites can be controlled by transjugular intrahepatic portosystemic shunt (TIPS) implantation, but specific pre-procedural outcome predictors are not well established. Liver and spleen stiffness measurement (LSM, SSM) correlate with outcome of compensated liver disease, but data for decompensated cirrhosis disease are scarce. Therefore, the predictive value of LSM and SSM was evaluated in patients with refractory ascites treated with TIPS insertion or receiving conservative therapy.

Material and Methods Patients with alcoholic liver cirrhosis and recurrent or refractory ascites were stratified according to TIPS eligibility. LSM was prospectively assessed by transient elastography (TE, XL probe) and point shear wave elastography (pSWE). pSWE was also used for SSM. The primary study endpoint was transplant-free survival after 12 months. In addition, correlation of LSM and SSM with TIPS complications was analyzed.

Results 43 patients (16 % female, age 55.5 [28.6 – 79.6] years) were recruited, n = 20 underwent TIPS and n = 23 were treated with repeated paracenteses only. 15 patients died and five underwent liver transplantation during follow-up. LSM and SSM at baseline did not predict the patients’ outcome in the TIPS cohort and in patients with conservative therapy. SSM was increased in two cases with spontaneous TIPS occlusion and declined after revision.

Conclusion LSM and SSM cannot be recommended for risk stratification in cirrhotic patients with refractory ascites. SSM may be useful in monitoring TIPS function during follow-up.

Zusammenfassung

Hintergrund Die aszitische Dekompensation bei fortgeschrittener alkoholinduzierter Leberzirrhose kann durch Implantation eines transjugulären intrahepatischen portosystemischen Shunts (TIPS) kontrolliert werden. Spezifische Marker zur Prognosebeurteilung vor TIPS-Implantation sind jedoch unzureichend evaluiert. In dieser Studie wurde daher der prädiktive Wert der Messung von Leber- und Milzsteifigkeit (LSM, SSM) bei Patienten mit therapierefraktärem Aszites untersucht.

Material und Methoden Patienten mit alkoholinduzierter Leberzirrhose und aszitischer Dekompensation wurden prospektiv rekrutiert und nach der Eignung für eine TIPS-Anlage stratifiziert. LSM wurde mit transienter Elastografie und point shear wave elastography (pSWE) bestimmt, pSWE wurde zudem für SSM verwendet. Primärer Endpunkt war das Überleben ohne Lebertransplantation nach 12 Monaten.

Ergebnisse 43 Patienten (16 % weiblich, medianes Alter 55,5 Jahre) wurden eingeschlossen (n = 20 TIPS, n = 23 konservative Therapie). 20 Patienten verstarben oder erhielten eine Lebertransplantation im Beobachtungszeitraum. LSM und SSM korrelierten weder in der Gesamtkohorte noch in der TIPS-Kohorte mit dem Patientenoutcome. Bei zwei Fällen eines spontanen TIPS-Verschlusses korrelierte SSM mit der Stentfunktion.

Schlussfolgerung LSM und SSM sind für die Risiko-Stratifizierung von Patienten mit Leberzirrhose und therapierefraktärem Aszites nicht geeignet. SSM kann jedoch für das Monitoring der TIPS-Funktion genutzt werden.

Key words

transient elastography (TE) - point shear wave elastography (pSWE) - refractory ascites - transjugular intrahepatic portosystemic shunt (TIPS) - decompensated cirrhosis - spleen stiffness

Schlüsselwörter

Transiente Elastographie (TE) - point shear wave elastography (pSWE) - therapierefraktärer Aszites - Transjugulärer intrahepatischer portosystemischer Shunt (TIPS) - dekompensierte Leberzirrhose - Milzsteifigkeit

^* FL and RM contributed equally to this work.

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