Accuracy of splenic stiffness measurement for predicting clinically significant varices in children with portal hypertension: a systematic review and diagnostic test accuracy meta-analysis
Aditi Kumar, Ranjan Kumar Patel, Vijay Kumar KrishnegowdaObjective
To evaluate the diagnostic accuracy of splenic stiffness measurement (SSM) for detecting clinically significant varices (CSV) in children with portal hypertension (PHTN), including non-cirrhotic portal hypertension (NCPH) and chronic liver disease (CLD).
Design
Systematic review and diagnostic test accuracy meta-analysis.
Data sources
MEDLINE (via PubMed), Embase and Scopus were searched from inception to 31 July 2025. No language or time limitations were applied.
Eligibility criteria
We included prospective and retrospective studies which had children (<18 years) with clinically, radiologically, biochemically or histologically diagnosed PHTN. The index test was SSM (transient elastography, 2D-shear wave elastography (SWE) or point-SWE/acoustic radiation force impulse (ARFI)). The reference standard was oesophagogastroduodenoscopy. Studies with other reference standards, like liver biopsy, were excluded.
Data extraction and synthesis
Two reviewers independently extracted data. A Bayesian random-effects bivariate model was used to estimate summary sensitivity and specificity with 95% credible intervals (CrIs), and hierarchical summary receiver operating characteristic curves were constructed. Risk of bias was assessed using QUADAS-2, and certainty of evidence (COE) was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach.
Results
21 studies were included in the systematic review and 14 (n=1027) were eligible for meta-analysis. For CLD (8 studies, n=405), summary sensitivity was 83.0% (95% CrI 69.9% to 91.0%) and specificity was 75.7% (60.8%–85.2%), showing low certainty for CSV. In NCPH (6 studies, n=171), sensitivity for CSV was 92.5% (82.7%–97.0%) and specificity was 80.3% (57.6%–92.7%), with moderate COE for sensitivity and low COE for specificity.
Conclusions
SSM probably has high sensitivity and may have moderate specificity for detecting CSV in children with NCPH. In CLD, diagnostic accuracy remains uncertain due to low COE. Further well-designed, aetiology-specific studies are needed to establish the role of SSM in the clinical pathway.
PROSPERO registration number
CRD42024579988.