Portal de Periódicos da CAPES

Reply to: “Definition of SPSS: we need to speak the same language”

2020; Elsevier BV; Volume: 73; Issue: 2 Linguagem: Inglês

10.1016/j.jhep.2020.04.012

1600-0641

Michael Praktiknjo, Jordi Torner, Macarena Simón‐Talero, Wen Gu, Antoni Pérez Poch, Cristina de la Torre, Inés del Val, Francesc Alpiste, Joan Genescà, Jonel Trebicka,

Hepatitis Viruses Studies and Epidemiology

We appreciate the interest of Nicoară-Farcău et al. in our recent multicenter study published in Journal of Hepatology.[1]Praktiknjo M. Simón-Talero M. Römer J. Roccarina D. Martínez J. Lampichler K. et al.Total area of spontaneous portosystemic shunts independently predicts hepatic encephalopathy and mortality in liver cirrhosis.J Hepatol. 2020; 72: 1140-1150Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar The authors raise issues related to the lack of consensus on the definition of spontaneous portosystemic shunt (SPSS). In fact, the lack of data on SPSS was the reason for members of the international Baveno cooperation to form the Baveno VI-SPSS group and to conduct the largest studies on this topic so far.[1]Praktiknjo M. Simón-Talero M. Römer J. Roccarina D. Martínez J. Lampichler K. et al.Total area of spontaneous portosystemic shunts independently predicts hepatic encephalopathy and mortality in liver cirrhosis.J Hepatol. 2020; 72: 1140-1150Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar,[2]Simón-Talero M. Roccarina D. Martínez J. Lampichler K. Baiges A. Low G. et al.Association between portosystemic shunts and increased complications and mortality in patients with cirrhosis.Gastroenterology. 2018; 154: 1694-1705.e4Abstract Full Text Full Text PDF PubMed Scopus (66) Google Scholar In response to Nicoară-Farcău and colleagues, we agree that gastrorenal shunts seem important, as they are found in many patients with gastric varices and therefore possibly associate with bleeding. In total, 990 SPSSs in patients with available follow-up data were found. The distribution of SPSSs is shown in Table 1. Moreover, we calculated the fraction of patients developing variceal bleeding according to the presence of a certain SPSS type. The rate of variceal bleeding in patients with gastrorenal shunt was 12.2%, not significantly different from other types of SPSS (Table 1). A possible reason for this finding is the current lack of radiologic predictors of progression of SPSS due to the cross-sectional design of our study.[3]Berzigotti A. Merkel C. Magalotti D. Tiani C. Gaiani S. Sacerdoti D. et al.New abdominal collaterals at ultrasound: a clue of progression of portal hypertension.Dig Liver Dis. 2008; 40: 62-67Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar However, splanchnic and systemic hemodynamics in cirrhotic patients can change and longitudinal studies on the dynamics of SPSSs are needed. Another possible reason for this finding relates to difficulties quantifying SPSSs. Currently, those measurements need to be performed manually by a trained professional. This is especially challenging for (para-)esophageal varices, which tend to build collateral networks, which are almost impossible to quantify by hand. Hence, these were not quantified in our recent studies. However, automated, computer-assisted quantification of SPSS could be a solution. Currently, we have developed a computer application based on image processing. This application, based on MATLAB, measures the diameter of each shunt and automatically calculates the cross-sectional area of the SPSS, through image processing, independently of whether it is CT or MRI (see supplementary video). This application may facilitate the calculation of total shunt area and may save significant time for healthcare professionals.Table 1Distribution of different types of SPSS.Type of SPSSTotalNo BleedingBleedingPercentageSplenorenal3843285614.6Mesocaval6758913.4Mesorenal98111.1Inferior mesenteric-caval2219313.6Gastrorenal4943612.2Umbilical4203477317.4Others3935410.3SPSS, spontaneous portosystemic shunt. Open table in a new tab SPSS, spontaneous portosystemic shunt. In conclusion, we acknowledge that we need a unified definition of SPSS. Using modern computer-assisted techniques might help us overcome technical obstacles to quantifying all SPSSs, leading us to refer to the same definition in the future. Jonel Trebicka is supported by grants from the Deutsche Forschungsgemeinschaft (SFB TRR57), Cellex Foundation and European Union's Horizon 2020 research and innovation program (No 668031). Joan Genescà is a recipient of a Research Intensification grant from Instituto de Salud Carlos III , Spain. The study was partially funded by grants PI15/00066, and PI18/00947 from Instituto de Salud Carlos III and co-funded by European Union (ERDF/ESF, "Investing in your future"). Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivasis supported by Instituto de Salud Carlos III . Macarena Simón-Talero is a recipient of the grant JR 17/00029 from Instituto de Salud Carlos III . The funders had no influence on study design, data collection and analysis, decision to publish or preparation of the manuscript. MP, JT, acquisition of data, analysis and interpretation of data, drafting of the manuscript. MST, FA, AP, CT, IV: acquisition of data, analysis and interpretation of data. JG, JT: drafting of the manuscript, critical revision of the manuscript regarding important intellectual content. First, we select the image (CT/MRI). Once the image is uploaded, we press the detection button in order to select the area of the SPSS. Automatically, the area will appear below the image. If we need to select more SPSS, we can repeat the process. Finally, the total SPSS area is shown. The authors declare no conflicts of interest that pertain to this work. Please refer to the accompanying ICMJE disclosure forms for further details. Download .pdf (.33 MB) Help with pdf files disclosures.pdfeyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiJjN2M3NDIxNDIzNjg4OGMyNDdlMmM4NDM3NTRjNmZiNyIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjMxNzk1ODAwfQ.FTmIZL7yzwFJ8oOJnfrL8hQD7907XWT5bQCG68PTOBsWYgwbS7B8lQYRfFLpHs65Z-B1b0rJpK-Cp9xfJ5LKCDbQuMXbwy-ydXNct43ZVdzpRu7Cxp4c2Lb4TFzgs1H9KeiqjKomzkiBsdSfvrdO0352UyWFO1y0fthL1KFsDlbka1zC3tL-v5LKCvremPmJ53BuehRSODx5GCM9gGIPoe-iCX_ELfNPoyEYuIAtFyCLsSTNio8snqof_lzsZ6lnslvixYQEmaZAjoqtUbUMPi0A-bSSt4R9oLGj9LSE5RFqn3sbmIEY_HgBRnezB1sienOFO9oN3YF1HSgY9GOiRw Download .mp4 (26.47 MB) Help with .mp4 files Supplementary VideoFirst, we select the image (CT/MRI). Once the image is uploaded, we press the detection button in order to select the area of the SPSS. Automatically, the area will appear below the image. If we need to select more SPSS, we can repeat the process. Finally, the total SPSS area is shown. Total area of spontaneous portosystemic shunts independently predicts hepatic encephalopathy and mortality in liver cirrhosisJournal of HepatologyVol. 72Issue 6PreviewSpontaneous portosystemic shunts (SPSS) frequently develop in liver cirrhosis. Recent data suggested that the presence of a single large SPSS is associated with complications, especially overt hepatic encephalopathy (oHE). However, the presence of >1 SPSS is common. This study evaluates the impact of total cross-sectional SPSS area (TSA) on outcomes in patients with liver cirrhosis. Full-Text PDF Open AccessDefinition of SPSS: we need to speak the same languageJournal of HepatologyVol. 73Issue 2PreviewWe read with great interest the recent international multicenter retrospective study published in Journal of Hepatology by Praktiknjo et al., assessing the impact of total cross-sectional spontaneous portosystemic shunt (SPSS) area (TSA) on outcomes in patients with cirrhosis.1 The authors found that a TSA >83 mm2 was associated with an increased risk of overt hepatic encephalopathy and mortality. This study, as well as their previous prominent work,2 shed light on the role of SPSS in the prognosis of cirrhosis, a role which should not be neglected. Full-Text PDF