Monitoring Liver and Spleen Stiffness Changes May Predict Clinical Response to Non-selective B-Blockers in Portal Hypertension: A Systematic Review and Meta-Analysis.

BACKGROUND

Treatment with non-selective b-blockers (NSBBs) is the mainstay of pharmacological management of portal hypertension (PH), but monitoring treatment response is not well standardized. Liver stiffness (LSM) and spleen stiffness measurement (SSM) changes have been used as non-invasive biomarkers of PH and are associated with disease progression and liver-related events. This systematic review examined LSM and SSM changes (ΔLSM, ΔSSM) in patients receiving NSBBs and their ability to predict treatment response.

METHODS

A literature search was performed to identify all published studies with patients with PH receiving NSBBs and monitoring with LSM and/or SSM. Pooled proportions, 95% confidence intervals (CI), and prediction intervals (PI) were calculated. The results of primary studies with varying diagnostic thresholds were plotted with a Summarized Receiver Operating Characteristic curve (SROC), and areas under the SROCs were compared.

RESULTS

The meta-analysis included eight studies and 445 patients with PH. The mean LSM percentage reduction was 12% (95%CI - 16, - 8; I = 0%), and the mean SSM percentage decline was 20% (95%CI - 51, 10; I = 89.6%). The pooled AUSROC of ΔLSM in detecting response to NSBBs was 0.727 (95%CI 0.50, 0.84) with a pooled diagnostic odds ratio (DOR) of 7.38 (95%CI 1.89, 28.8). ΔSSM showed a numerically higher (p = 0.516) diagnostic accuracy with a pooled AUSROC of 0.792 (95%CI 0.68, 0.89) and a pooled DOR of 10.69 (95%CI 2.1, 56.4).

CONCLUSION

Both LSM and SSM decrease significantly after NSBB treatment in patients with PH. However, ΔSSM appears to be superior to ΔLSM in predicting an effective treatment response.