ASSESSMENT OF SPLENIC STIFFNESS FOR MONITORING THERAPEUTIC RESPONSE TO NON-SELECTIVE BETA BLOCKERS IN PATIENTS WITH PORTAL HYPERTENSION: A SYSTEMATIC REVIEW

Abstract

Background- Portal hypertension is a major complication of liver cirrhosis, often requiring long-term therapy with non-selective beta blockers (NSBBs). Invasive methods like hepatic venous pressure gradient (HVPG) and endoscopy remain standard for assessing response but are limited by accessibility and patient acceptability. Splenic stiffness measurement (SSM) has emerged as a non-invasive alternative with potential clinical utility. Objectives- To evaluate the diagnostic accuracy and utility of splenic stiffness measurement for monitoring therapeutic response to NSBBs in patients with cirrhosis and portal hypertension. Methods- A systematic review of 10 original studies and 3 methodological/guideline articles was conducted. Studies assessing splenic stiffness using elastographic techniques (Transient Elastography, 2D Shear Wave Elastography, Magnetic Resonance Elastography) in cirrhotic patients undergoing NSBB therapy were included. Key outcomes included sensitivity, specificity, area under the ROC curve (AUC), cut-off values, and correlation with reference standards (HVPG, endoscopy). Results- The majority of included studies were prospective cohorts with low risk of bias. Splenic stiffness showed high diagnostic accuracy across studies, with sensitivity ranging from 74% to 89%, specificity from 70% to 83%, and AUC values consistently above 0.80. Suggested cut-off values for predicting significant portal hypertension or large varices ranged from 43.0 to 52.8 kPa. Transient Elastography was the most commonly used modality. Follow-up durations post-NSBB therapy ranged from 3 to 12 months. SSM consistently correlated with variceal changes and HVPG, suggesting it is a reliable surrogate marker. Conclusion- Splenic stiffness measurement is a promising, non-invasive tool for monitoring response to NSBB therapy in cirrhotic patients with portal hypertension. Its high diagnostic performance, reproducibility, and patient acceptability position it as a valuable adjunct to current invasive standards. Future research should focus on long-term outcomes, standardization of cut-off values, and integration into clinical practice guidelines.