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

doi:10.4240/wjgs.v13.i2.127

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World Journal of Gastrointestinal Surgery

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1948-9366

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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