Diagnostic accuracy of spleen stiffness to evaluate portal hypertension and esophageal varices in chronic liver disease: a systematic review and meta-analysis

Abstract

Objectives: To systematically review studies on the diagnostic accuracy of spleen stiffness measurement (SSM) for the detection of clinical significant portal hypertension (CSPH), severe portal hypertension (SPH), esophageal varices (EV), and high-risk esophageal varices (HREV) in patients with chronic liver diseases (CLD).

Methods: Through a systematic search, we identified 32 studies reporting the accuracy of SSM for the diagnosis of portal hypertension (PH) and/or EV in adults with CLD. A bivariate random-effects model was performed to estimate pooled sensitivity, specificity, likelihood ratio, positive predictive value (PPV), negative predictive value (NPV), and diagnostic odds ratios (DOR). The clinical utility of SSM was evaluated by Fagan plot.

Results: A total of 32 studies assessing 3952 patients were included in this meta-analysis. The pooled sensitivities of SSM were 0.85 (95% confidence interval (CI), 0.69-0.93) for CSPH; 0.84 (95% CI, 0.75-0.90) for SPH; 0.90 (95% CI, 0.83-0.94) for any EV; and 0.87 (95% CI, 0.77-0.93) for HREV. The pooled specificities of SSM were 0.86 (95% CI, 0.74-0.93) for CSPH; 0.84 (95% CI, 0.72-0.91) for SPH; 0.73 (95% CI, 0.66-0.79) for EV; and 0.66 (95% CI, 0.53-0.77) for HREV. Summary PPV and NPV of SSM for detecting HREV were 0.54 (95% CI, 0.47-0.62) and 0.88 (95% CI, 0.81-0.95), respectively.

Conclusions: Our meta-analysis suggests that SSM could be used as a helpful surveillance tool in management of CLD patients and was quite useful for ruling out the presence of HREV thereby avoiding unnecessary endoscopy.

Key points: • SSM could be used to rule out the presence of HREV in patients with CLD thereby avoiding unnecessary endoscopy. • SSM has significant diagnostic value for CSPH and SPH with high sensitivity and specificity in patients with CLD. • SSM could be used as a helpful surveillance tool for clinicians managing CLD patients.

Keywords: Diagnosis; Elasticity imaging techniques; Esophageal varices; Portal hypertension; Spleen.

Fig. 1

Flow chart of study selection process

Fig. 2

Quality assessment of the included studies according to Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) criteria

Fig. 3

Sensitivity and specificity forest plots of spleen stiffness measurement (SSM) for detecting CSPH (a), SPH (b), EV (c), and HREV (d)

Fig. 4

Hierarchical summary receiver operating characteristic (HSROC) curve of spleen stiffness measurement (SSM) for detecting CSPH (a), SPH (b), EV (c), and HREV (d)