A Prospective Study of Hepatic Vein Waveform, Damping Index, and Splenoportal Index in Liver Cirrhosis: Correlation with Child-Pugh Score
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Abstract
Background:Chronic liver disease evaluation is commonly conducted using the Child-Pugh and Model for End-Stage Liver Disease (MELD) scoring systems. While the hepatic venous pressure gradient (HVPG) is the gold standard for measuring portal hypertension in cirrhotic patients, non-invasive alternatives such as Doppler ultrasonography offer a cost-effective, rapid, and less invasive option for assessment.
Objective: This study aimed to investigate the correlation between hepatic vein waveform patterns, damping index, splenoportal index, and the Child-Pugh score in patients with liver cirrhosis to evaluate the efficacy of Doppler ultrasound as a non-invasive diagnostic tool.
Methods: A prospective cross-sectional study was conducted at the Radiology Department of a public teaching hospital in Rawalpindi, Pakistan, from December 2023 to June 2024. A total of 52 patients with liver cirrhosis were included after excluding those with incomplete data or confounding conditions. Doppler ultrasound was used to assess hepatic vein waveform patterns, damping index, and splenoportal index. The Child-Pugh score was calculated based on clinical and laboratory parameters. Statistical analysis was performed using SPSS version 25, with a p-value of <0.05 considered significant. The chi-square test, Fisher’s exact test, ANOVA, and ROC curve analyses were utilized for data evaluation.
Results: The final cohort consisted of 52 patients, with 39 males (75%) and 13 females (25%). The mean age was 55.3 years. The damping index showed a significant increase from Child-Pugh Class A (0.45 ± 0.10) to Class C (0.75 ± 0.15) (p=0.003). The splenoportal index also demonstrated a significant rise from Class A (1.4 ± 0.3) to Class C (2.0 ± 0.5) (p=0.015). The sensitivity and specificity of the damping index (> 0.6) in predicting higher Child-Pugh scores (B + C) were 52.6% and 85.7%, respectively, with a positive predictive value of 90.9%.
Conclusion: The study found strong correlations between the severity of liver cirrhosis, as assessed by the Child-Pugh score, and Doppler ultrasound parameters such as hepatic vein waveforms and the damping index. Doppler ultrasound, therefore, presents itself as a precise, non-invasive alternative for evaluating the severity of liver disease, potentially replacing more invasive procedures.
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