Noninvasive Tools and Risk of Clinically Significant Portal Hypertension and Varices in Compensated Cirrhosis: The "Anticipate" Study
Noninvasive Tools and Risk of Clinically Significant Portal Hypertension and Varices in Compensated Cirrhosis: The "Anticipate" Study
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DOI：
10.1002/hep.28824
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发表时间：
2016-12-01
期刊：
影响因子：
13.5
通讯作者：
Berzigotti, Annalisa
中科院分区：
文献类型：
--
作者：
Abraldes, Juan G.;Bureau, Christophe;Berzigotti, Annalisa
在代偿性晚期慢性肝病（cACLD）患者中，临床上显着的门脉高压（CSPH）和需要治疗的静脉曲张（VNT）的存在具有预后和治疗意义。我们的目标是开发基于无创测试的风险预测模型，为 cACLD 患者提供即时风险评估。我们分析了来自欧洲/加拿大五个中心的 518 名 cACLD 患者，采用配对无创测试（通过瞬时弹性成像测量肝脏硬度 [LSM]、血小板计数和脾直径，并计算肝脏硬度与脾/血小板评分 [LSPS] 评分和血小板-脾比 [PSR]）和内窥镜/肝静脉压力梯度测量。使用逻辑回归对 CSPH、静脉曲张和 VNT 的风险进行建模。所有无创测试都能可靠地识别出 CSPH 高风险患者，而 LSPS 的辨别率最高。 LSPS 值高于 2.65 与 CSPH 风险高于 80% 相关。没有一项测试能够识别出各种大小静脉曲张风险非常低的患者，但 LSPS 和结合 TE 和血小板计数的模型都识别出了风险非常低的患者（
In patients with compensated advanced chronic liver disease (cACLD), the presence of clinically significant portal hypertension (CSPH) and varices needing treatment (VNT) bears prognostic and therapeutic implications. Our aim was to develop noninvasive tests-based risk prediction models to provide a point-of-care risk assessment of cACLD patients. We analyzed 518 patients with cACLD from five centers in Europe/Canada with paired noninvasive tests (liver stiffness measurement [LSM] by transient elastography, platelet count, and spleen diameter with calculation of liver stiffness to spleen/platelet score [LSPS] score and platelet-spleen ratio [PSR]) and endoscopy/hepatic venous pressure gradient measurement. Risk of CSPH, varices, and VNT was modeled with logistic regression. All noninvasive tests reliably identified patients with high risk of CSPH, and LSPS had the highest discrimination. LSPS values above 2.65 were associated with risks of CSPH above 80%. None of the tests identified patients with very low risk of all-size varices, but both LSPS and a model combining TE and platelet count identified patients with very low risk (