Proposed Topic (Most preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Authors (including presenting author) :
Lam YY (1), Lam CY (1), Chan KTL (1), Lai SW (1), Yuen WH (1)
Affiliation :
(1) Department of Medicine and Geriatrics, Pok Oi Hospital
Introduction :
According to the Baveno VII agreement, the most recent international guideline for portal hypertension, "Personalized Care for Portal Hypertension" is recommended and will become the new trend in establishing care plans for patients with liver cirrhosis. Portal hypertension is a common complication of liver cirrhosis, causing ascites, bleeding from esophageal varices (EV), and encephalopathy. The use of non-invasive diagnostic methods for compensated cirrhosis or compensated advanced chronic liver disease may aid in decompensation prevention and acute bleeding management.
Objectives :
This study evaluated the utility of shear-wave elastography in splenic stiffness measurement (SSM) as a noninvasive assessment for EV prediction and attempted to determine the cut-off value of SSM for EV prediction.
Methodology :
According to the Baveno VII consensus, severe portal hypertension is ruled out if at least two of the following occur: LSM <= 15 kPa, platelet count >= 150 × 10^9 platelets per L, and SSM <= 40 kPa. Ruled in if at least two of the following are present: LSM >= 25 kPa, platelet count <= 150 × 10^9 platelets per L, and SSM >=40 kPa. For Chinese, we use LSM 20 kPa as a norm. Furthermore, we used SSM on patients with LSM >20 kPa to improve the sensitivity of EV predictions. From the first quarter of 2023 to the fourth quarter of 2023, 40 patients (control group: n=20, cirrhosis group (LSM>=20 kPa): n=20) underwent LSM and SSM at the POH M&G department.
Result & Outcome :
The control group included all non-cirrhotic patients who met the Baveno VII rule out criteria. Some patients in the control group underwent upper endoscopy for other reasons. We acquired a sensitivity of 100% for EV free. Patients with LSM>20 kPa in the cirrhotic group received SSM during normal nurse clinic visits. We achieved 70% sensitivity in EV prediction. The remaining 30% did not have an upper endoscopy for confirmation. Combining the Baveno VII criteria with SSM produced good results and reduced the diagnostic grey zone for clinically severe portal hypertension. With this additional step, SSM applied to patients with LSM>20 kPa could improve the sensitivity of EV prediction, making it a promising tool to include in nurse clinic sessions. Recommendation: Future studies should evaluate the cut-off value for SSM in grey zone and avoid the unnecessary upper endoscopy for EV prediction. Meanwhile, future studies should also evaluate whether SSM-based diagnosis allows for the identification of patients who would benefit from non-selective β-blocker treatment.
