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Alanine aminotransferase and spleno-portal dynamics affect spleen stiffness measured by point shear-wave elastography in patients with chronic hepatitis C in the absence of significant liver fibrosis

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Abstract

Background

Spleen stiffness (SS) has gained a lot of interest in the context of liver cirrhosis and portal hypertension stratification. However, there is a paucity of data on confounding factors that may alter SS values.

Methods

Between January 2018 and October 2019, we enrolled 120 healthy subjects and 117 patients with hepatitis C virus (HCV) infection who did not have significant liver fibrosis (i.e., F0–1). Abdominal ultrasound evaluation was performed on each individual to measure portal vein diameter, portal flow velocity, spleen bipolar diameter, and splenic area. We also performed liver and spleen elastography.

Results

HCV patients had higher SS (p < 0.001), portal vein diameter (p = 0.031), portal flow velocity (p = 0.035), spleen bipolar diameter (p = 0.042) and area (p = 0.025), and ALT levels (p < 0.001). Linear regression models showed that SS increased by 3.220 kPa for each mm of portal vein diameter, by 0.7 kPa for each cm/s of portal flow velocity, by 2.239 kPa for each cm of spleen bipolar diameter, and by 0.233 kPa for each cm2 of spleen area. Patients with HCV infection were stratified according to median ALT levels (i.e. 32 IU/L). SS and spleno-portal axis parameters were significantly higher in patients with an ALT level > 32 IU/L. Besides, the relationship between SS and ALT was described by cubic polynomial regression according to the following equation: 11.735 + 0.404 (ALT)1 − 0.002 (ALT)2 + 4.26 × 10–6 (ALT)3.

Conclusions

Our results bring new light to the role of inflammation as a confounding factor for SS measurement. Therefore, particular attention should be paid to serum transaminase for a correct evaluation of spleen elastography.

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Authors and Affiliations

  1. Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy

    Mauro Giuffrè, Sofia Fouraki, Michele Campigotto, Anna Colombo, Alessia Visintin, Matteo Rossano Buonocore, Alessandro Aversano, Martina Budel & Lory Saveria Crocè

  2. Liver Clinic, Azienda Sanitaria Universitaria Giuliano-Isontina, Ospedale Cattinara, Trieste, Italy

    Fabio Tinè, Cristiana Abazia, Flora Masutti & Lory Saveria Crocè

  3. Italian Liver Foundation, Basovizza (Trieste), Italy

    Lory Saveria Crocè

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  1. Mauro Giuffrè
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Correspondence to Mauro Giuffrè.

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Giuffrè, M., Fouraki, S., Campigotto, M. et al. Alanine aminotransferase and spleno-portal dynamics affect spleen stiffness measured by point shear-wave elastography in patients with chronic hepatitis C in the absence of significant liver fibrosis. J Ultrasound 24, 67–73 (2021). https://doi.org/10.1007/s40477-020-00456-9

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