Hepatic venous waveform, damping index, and splenoportal index in cirrhotic patients: Their correlation with Child–Pugh classification and esophageal varice

Abstract Background: Cirrhosis is a chronic liver disease characterized by fibrosis and regenerative nodules, leading to changes in hepatic blood vessel structure and reduced liver function. This study aims to assess hepatic venous waveform patterns and the splenoportal index (SPI) using Doppler ultrasonography in patients with cirrhosis and to investigate the relationship between these parameters and the Child–Pugh classification. Materials and Methods: A prospective observational study was conducted over 24 months at a tertiary care hospital, involving 54 patients diagnosed with liver cirrhosis based on history, physical examination, relevant blood investigations, abdominal ultrasound sonography, and Shear wave Elastography/FIBROSCAN. Doppler ultrasonography was used to evaluate hepatic vein velocity, spectral waveform patterns, damping index (DI), and SPI. Liver disease severity was assessed using the Child–Pugh scoring system. All patients underwent clinical assessments and laboratory testing, including complete blood counts and liver function tests. Statistical analyses were performed to determine correlations between imaging findings and clinical severity. Results: A significant correlation was observed between higher Child–Pugh classes and abnormal Doppler ultrasound findings. The DI demonstrated a statistically significant relationship with the Child–Pugh score ( P = 0.004). Esophageal varices were present in 51.85% of patients and were strongly correlated with elevated SPI values. The distribution of hepatic vein waveform patterns was as follows: monophasic in 46.29%, biphasic in 27.77%, and triphasic in 25.92% of cases. A DI >0.6 was seen in 72.22% of patients, and an SPI >3.0 was noted in 70.37% of cases. Conclusion: Hepatic venous Doppler ultrasonography DI and SPI measurements are valuable noninvasive tools for assessing the severity of liver cirrhosis and portal hypertension. Their strong correlation with the Child–Pugh classification and presence of esophageal varices support their potential use in routine clinical evaluations. Further large-scale studies are recommended to confirm these results and improve their clinical application.