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. 2025 Nov-Dec;15(6):102596.
doi: 10.1016/j.jceh.2025.102596. Epub 2025 May 27.

Spleen Area Affects the Performance of the Platelet Count-Based Non-invasive Tools in Predicting First Hepatic Decompensation in Metabolic Dysfunction-Associated Steatotic Liver Disease Cirrhosis

Marcello Dallio  1 , Mario Romeo  1 , Fiammetta Di Nardo  1 , Carmine Napolitano  1 , Paolo Vaia  1 , Simone Olivieri  1 , Marco Niosi  1 , Alessandro Federico  1
Affiliations

Spleen Area Affects the Performance of the Platelet Count-Based Non-invasive Tools in Predicting First Hepatic Decompensation in Metabolic Dysfunction-Associated Steatotic Liver Disease Cirrhosis

Marcello Dallio et al. J Clin Exp Hepatol. 2025 Nov-Dec.

Abstract

Background/aims: Various non-invasive tools (NITs) predicting first hepatic decompensation (HD) in advanced chronic liver disease (ACLD) enclose platelet (PLT) count. A relevant proportion of metabolic dysfunction-associated steatotic liver disease (MASLD)-ACLD patients do not show splenomegaly- and hypersplenism-related thrombocytopenia. We aimed to evaluate the performance of NITs in predicting HD according to ultrasound-assessed spleen size.

Methods: In this observational study, 148 splenic and 27 asplenic (ASP) MASLD-compensated advanced chronic liver disease (cACLD) patients were enrolled. Ultrasound artificial intelligence-based tools distinguished splenomegaly-affected patients (SAPs) and normal-spleen patients (NSPs). Albumin-Bilirubin score (ALBI) and PLT count-based NITs (PLNs) (Fbrosis-4 [FIB-4], ALBI-FIB-4, red cell distribution width-to-PLT ratio [RPR], liver stiffness measurement [LSM]-to-platelet ratio [LSM/PLTr], and ANTICIPATE ± non-alcoholic steatohepatitis [NASH]) were determined. Over 3 years, the first HD was recorded.

Results: Limitedly to SAP, spleen area inversely correlated with PLT (relationship [R]: -0.981; P < 0.0001), confirming the role of splenomegaly-related hypersplenism in conditioning thrombocytopenia. HD occurred similarly in SAPs (20.48%), NSPs (21.15%), and ASP patients (25%) (P: 0.198). In NSP, PLNs showed a reduced influence on HD (FIB-4 [P: 0.03], ALBI-FIB-4 [P: 0.001], RPR [P: 0.002], LSM/PLTr [P: 0.01], and ANTICIPATE ± NASH [P: 0.001]) compared to SAP. In NSP, the spleen area was inversely associated (adjusted sub-distribution hazard ratio: 0.870) and more significantly (P < 0.0001) impacted HD. Consistently, unlike SAPs, in NSPs and ASP patients, PLNs showed poor performance, and exclusively ALBI maintained a good accuracy (NSP: area under the curve [AUC]: 0.651, P: 0.04; ASP patients: AUC: 0.625, P: 0.03) in predicting 3-year HD.

Conclusion: Ultrasound-assessed spleen size affects the predictive performance of the PLNs in MASLD-cACLD patients.

Keywords: liver cirrhosis; liver related events; predictive model; spleen area; ultrasound.

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Conflict of interest statement

All the authors declare no conflict of interest and no competing interests.

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