Shear wave elastography to predict oesophageal varices, morbidity and mortality in chronic liver disease

In chronic liver disease (CLD), Fibroscan® (transient elastography) can be a useful "rule-out" test for oesophageal varices, but it is limited by body habitus. Shear wave elastography (SWE) is another non-invasive fibrosis test that is better suited for overweight subjects. We determined SWE's ability to predict oesophageal varices, morbidity and mortality in a predominantly overweight population.

Subjects (n=1,120) with CLD who underwent SWE at Middlemore Hospital between 1 July 2015 and 30 June 2018 were identified. The diagnostic accuracy of SWE to rule out oesophageal varices in advanced hepatic fibrosis was assessed, as well as associations with morbidity and mortality.

Of 304 subjects with advanced fibrosis, 89 had endoscopic data and 18 had varices. Median body mass index was 28.2kg/m2. Area under the receiver operating characteristic curve value for liver stiffness to predict varices was 0.74 and 0.80 when combined with serum albumin. Liver stiffness ≤12.4kPa and albumin ≥37g/L had a negative predictive value of 95%. There were 135 hospital admissions and 19 deaths. Liver stiffness correlated with hospital admissions (p=0.007) and independently predicted mortality.

Shear wave elastography could be a useful rule-out test for screening endoscopy in overweight populations with CLD.