Model for liver hardness using two-dimensional shear wave elastography, durometer, and preoperative biomarkers

doi:10.4240/wjgs.v13.i2.127

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 13, Issue 2

This Article

Academic Content and Language Evaluation of This Article

CrossCheck and Google Search of This Article

Academic Rules and Norms of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Number of Hits and Downloads for This Article

Total Article Views (4384)

All Articles published online

The chart showing PDF series, WORD series, HTML series, Figures (1-3) series, Tables (1-5) series.

Item

Count

PDF

277

WORD

157

HTML

2053

Figures (1-3)

315

Tables (1-5)

288

Sum=3090

Publishing Process of This Article

The chart showing Browse series, Download series.

Item

Count

Browse

476

Download

818

Sum=1294

Feb 27, 2021 (publication date) through Apr 22, 2024

Times Cited of This Article

Times Cited (1)

Journal Information of This Article

Publication Name

World Journal of Gastrointestinal Surgery

ISSN

1948-9366

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Gastrointest Surg. Feb 27, 2021; 13(2): 127-140
Published online Feb 27, 2021. doi: 10.4240/wjgs.v13.i2.127

Table 1 Patient characteristics from both cohorts

Parameters	Derivation cohort, n = 74	Validation cohort, n = 162	P value
Age in yr, median (IQR)	61 (52-66)	57 (20-63)	0.063
INR, median (IQR)	1 (0.95-1.07)	1.05 (1-1.1)	< 0.001
PT in s, median (IQR)	12.5 (11.8-13)	11.7 (11.2-12.5)	< 0.001
TT in s, median (IQR)	18.5 (16.8-19.5)	18.4 (17.2-19.1)	0.426
Platelet as 10⁹/L, median (IQR)	165 (125-232)	156 (116-214)	0.547
Albumin in g/L, median (IQR)	43 (39.4-45.7)	44.3 (40.3-47.2)	0.103
ALT in U/L, median (IQR)	25 (18-38.8)	26 (20-37)	0.644
AST in U/L, median (IQR)	24 (21-37)	27 (22-37)	0.301
TB in µmol/L, median (IQR)	13.2 (9.7-19.5)	12 (9-15)	0.017
Cholinesterase in U/L, median (IQR)	7310 (5844-8030)	6968 (5981-8298)	0.213
GGT in U/L, median (IQR)	44 (29-99)	46 (27-92)	0.136
Creatinine in μmol/L, median (IQR)	70 (62-79)	72 (64-83)	0.223
HBV–DNA in U/mL, median (IQR)	8 (0-1800)	0 (0-1074)	0.143
HBsAg in IU/mL, median (IQR)	24.9 (0-171.31)	250 (0-254)	0.823
HA in μg/L, median (IQR)	72 (47-113)	77 (44-213)	0.462
Stiffness in kPa, median (IQR)	9.3 (6.8-11.35)	10.1 (8.0-17)	0.022
Palpation scale, median (IQR)	57.5 (53.3-62.8)	-	-
Duration of surgery in min, median (IQR)	258 (193-318)	244 (147-328)	0.382
Hospital stay in d, median (IQR)	12 (7-19)	7 (6-10)	< 0.001
Child Pugh score, n (%)			0.080
A	67 (90.5)	157 (96.9)
B	7 (9.5)	5 (3.1)
Open surgery, n (%)	74 (100)	67 (41.4)	-
LH, n (%)	-	91 (56.2)	-
Open convert LH, n (%)	-	4 (2.4)	-
Major liver resection, n (%)	11 (14.9)	35 (21.6)	0.225
PHLF, n (%)	14 (18.9)	19 (11.7)	0.139
Grade A, n (%)	12 (16.1)	17 (10.5)
Grade B, n (%)	1 (1.4)	2 (1.2)
Grade C, n (%)	1 (1.4)	-

ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; FIB-4: Fibrosis-4; GGT: γ-Glutamine transpeptidase; HA: Hyaluronic acid; HBsAg: Hepatitis B surface antigen; INR: International normalized ratio; IQR: Interquartile range; LH: Laparoscopic hepatectomy; PHLF: Post-hepatectomy liver failure; PT: Prothrombin time; TB: Total bilirubin; TT: Thrombin time.

Table 2 Correlation between preoperative clinical parameters and durometer measurements

Parameters	Correlation coefficient R with subjective scale
Parameters	Pearson r (95%CI)	P value	Spearman r (95%CI)	P value
Age in yr	0.150 (-0.144-0.377)	0.201	0.024 (-0.211-0.273)	0.839
INR	0.097 (-0.125-0.306)	0.416	0.138 (0.127-0.350)	0.249
PT in s	0.197 (-0.122-0.318)	0.093	0.139 (-0.172-0.353)	0.239
TT in s	0.232 (-0.086-0.376)	0.046	0.219 (-0.055-0.406)	0.061
Platelet as 10⁹/L	–0.244 (-0.405-0.043)	0.039	-0.313 (-0.475-0.071)	0.008
Albumin in g/L	–0.382 (-0.522-0.073)	0.005	-0.359 (-0.518-0.037)	0.002
ALT in U/L	0.144 (-0.003-0.327)	0.227	0.299 (-0.088-0.441)	0.011
AST in U/L	0.192 (0.034-0.417)	0.106	0.340 (-0.071-0.469)	0.004
TB in µmol/L	0.015 (-0.165-0.151)	0.901	-0.049 (-0.278-0.241)	0.683
Cholinesterase in U/L	–0.298 (-0.479-0.104)	0.026	–0.263 (-0.476-0.000)	0.05
GGT in U/L	0.053 (-0.121-0.149)	0.662	0.043 (-0.257-0.244)	0.719
Creatinine in μmol/L	0.152 (-0.067-0.280)	0.205	0.298 (-0.144-0.342)	0.012
HBV–DNA in U/mL	-0.043 (-0.012-0.185)	0.749	0.110 (-0.070-0.538)	0.415
HBsAg in IU/mL	0.269 (-0.345-0.390)	0.023	0.358 (0.018-0.612)	0.002
HA in μg/L	0.547 (0.176-0.661)	< 0.001	0.578 (0.246-0.723)	< 0.001
Preoperative FIB–4	0.128 (-0.085-0.474)	0.284	0.378 (0.084-0.633)	0.001
Stiffness in kPa	0.704 (0.607-0.789)	< 0.001	0.769 (0.639-0.850)	< 0.001
Palpation scale	0.729 (0.524-0.861)	< 0.001	0.729 (0.509-0.859)	< 0.001
Hospital stay in d	0.261 (0.059-0.420)	0.042	0.352 (0.123-0.561)	0.005

ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; CI: Confidence interval; FIB-4: Fibrosis-4; GGT: γ-Glutamine transpeptidase; HA: Hyaluronic acid; HBsAg: Hepatitis B surface antigen; INR: International normalized ratio; PT: Prothrombin time; TB: Total bilirubin; TT: Thrombin time.

Table 3 Parameter estimates of the best multiple linear regression models for durometer

Term	Estimate	SD	T ratio	Sig
Intercept	27.172	2.173	12.506	< 0.001
Stiffness	0.414	0.076	5.417	< 0.001
Albumin	-0.103	0.042	-2.490	0.017
HBsAg	0.001	0.000	2.181	0.035

HBsAg: Hepatitis B surface antigen; SD: Standard deviation; Sig: Significant.

Table 4 Differences of characteristics for high and low hardness scale groups

Characteristics	Median (IQR)
Characteristics	High, n = 22	Low, n = 52	P value
Age in yr	64 (60-69)	56 (51-65)	0.042
INR	1.04 (0.97-1.07)	1.00 (0.96-1.05)	0.350
PT in s	12.5 (11.8-13.0)	12.5 (11.8-13.9)	0.0.578
Platelet as 10⁹/L	126 (80-162)	184 (136-244)	0.026
Albumin in g/L	40 (37-42)	45 (43-47)	< 0.001
ALT in U/L	23.0 (16.0-49.0)	27.0 (17.5-34.5)	0.966
AST in U/L	24.0 (21.0-28.0)	23.0 (18.0-42.0)	0.608
TB in µmol/L	11.8 (8.3-14.2)	13.5 (9.4-20.6)	0.365
Cholinesterase in U/L	4960 (4600-7329)	7523 (6845-8254)	0.004
Creatinine in μmol/L	77.0 (60.0-85.0)	67.0 (60.5-75.0)	0.625
HA in μg/L	142.0 (76.5-184.5)	58.2 (42.5-82.1)	< 0.001
HBsAg in IU/mL	170.1 (1.7-591.0)	24.9 (0.0-131.3)	0.026
Stiffness in kPa	13.6 (12.3-15.5)	7.9 (6.4-9.3)	< 0.001
Durometer in DU	28.6 (27.8-31.4)	25.3 (23.7-27.6)	< 0.001
Palpation scale	64.0 (60.0-70.0)	55.0 (50.4-60)	< 0.001
Major resection, %	6 (27.3%)	5 (9.6%)	0.138
PHLF, %	8 (36.4%)	6 (11.5%)	0.004
Duration of surgery in min	275 (175-310)	265 (185-343)	0.340
Postoperative hospital stays in d	15 (11-22)	9 (6-16)	0.047

ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; FIB-4: Fibrosis-4; HA: Hyaluronic acid; HBsAg: Hepatitis B surface antigen; INR: International normalized ratio; IQR: Interquartile range; PHLF: Post-hepatectomy liver failure; PT: Prothrombin time; TB: Total bilirubin; TT: Thrombin time.

Table 5 Risk factors for post-hepatectomy liver failure

Factors	Univariate analysis		Multivariate analysis
Factors	Odds ratio (95%CI)	P value	Odds ratio (95%CI)	P value
Age > 60 yr	2.339 (0.660-8.288)	0.188	-	-
INR ≥ 1.1	2.200 (0.344-14.079)	0.405	-	-
Platelet < 150 × 10⁹/L	4.316 (1.156-16.119)	0.030	3.156 (0.600-16.607)	0.175
Albumin ≤ 42 g/L	4.022 (1.128-14.335)	0.032	-	-
TB > 17.1 μmol/L	1.195 (0.367-3.890)	0.768	-	-
ALT ≥ 44 U/L	5.000 (1.336-18.710)	0.017	5.002 (0.926-27.022)	0.061-
Durometer > 27.38 DU	5.667 (1.278-25.114)	0.022	-	-
Stiffness ≥ 12 kPa	5.467 (1.363-21.924)	0.017	-	-
Hardness scale > 27.87	8.867 (1.937-40.595)	0.005	7.835 (1.486-41.306)	0.015
Major liver resection	5.100 (1.331-19.538)	0.017	4.616 (1.149-18.553)	0.031

ALT: Alanine aminotransferase; CI: Confidence interval; INR: International normalized ratio; TB: Total bilirubin.

Citation: Ju BJ, Jin M, Tian Y, Zhen X, Kong DX, Wang WL, Yan S. Model for liver hardness using two-dimensional shear wave elastography, durometer, and preoperative biomarkers. World J Gastrointest Surg 2021; 13(2): 127-140
URL: https://www.wjgnet.com/1948-9366/full/v13/i2/127.htm
DOI: https://dx.doi.org/10.4240/wjgs.v13.i2.127