PTU-034 Spleen stiffness by elastPQ point shear wave elastography predicts clinically significant portal hypertension in PBC

Introduction There is an ongoing effort to identify non-invasive surrogates for staging liver disease and detecting clinically significant portal hypertension (CSPH), defined as the presence of gastro-oesophageal varices on endoscopy. The correlation of spleen stiffness measurement (SSM) with portal hypertension measured by hepatic venous pressure gradient has been reported, but data regarding its reliability are controversial. We assessed the ability of liver stiffness measurement (LSM) and SSM performed by point-shear wave elastography (pSWE) to detect CSPH in primary biliary cholangitis (PBC). Methods Predictors of CSPH were evaluated in 53 PBC patients who had an upper-GI endoscopy within 12 months of the elastographic assessment. Demographics, biochemical and ultrasonographic data were prospectively collected. Transient elastography (Fibroscan, Echosens) [F-TE], liver and spleen pSWE (ElastPQ, Philips Affiniti70G), and the most common clinical fibrosis scores were obtained. ROC curves were constructed to establish the performance of elastographic techniques and fibrosis scores in predicting CSPH. Results Mean age 57±12 years, 91% female. OVs were detected in 12 (23%) cases (4 at high-risk of bleeding). Variables significantly associated with CSPH at univariate analysis were: diagnosis of cirrhosis, Child-Pugh, MELD and Mayo risk score, spleen area and longitudinal diameter, platelets, albumin, ALT, INR, F-TE, ElastPQ LSM and SSM, LSPS (LSM*spleen diameter/platelets). SSM remained the only independent predictor of CSPH in all the multivariate models (OR 1.101; 95%CI 1.14–1.20; p F-TE and ElastPQ LSM showed good AUROCs (95%CI): 0.85 (0.72–0.99) and 0.80 (0.62–0.98), with best cut-off 14.3 and 13.8 kPa, respectively. However, specificity (Sp) was In this cohort, the diagnostic performance of ElastPQ SSM in detecting CSPH was superior to the recently validated Baveno VI and Expanded Baveno VI criteria, which showed good Sp (77% and 87%, respectively) but low Se (67%, for both). Conclusions We provide evidence that transient elastography, in particular ElastPQ SSM, can be used as a reliable tool for the detection of CSPH in PBC.