Risk factors for portopulmonary hypertension in patients with cirrhosis: a prospective, multicenter study-猫眼课题宝

DOI：

10.1007/s12072-022-10456-y

发表时间：

2022-12

期刊：

Hepatology International

影响因子：

6.6

通讯作者：

中科院分区：

医学2区

文献类型：

作者：

M. Atsukawa;A. Tsubota;Chisa Kondo;Kaori Koyano;T. Ishikawa;H. Toyoda;K. Takaguchi;Tsunamasa Watanabe;K. Matsuura;C. Ogawa;A. Hiraoka;H. Okubo;Masakuni Tateyama;H. Uojima;A. Nozaki;M. Chuma;Keizo Kato;S. Mikami;J. Tani;A. Morishita;K. Kawata;T. Tada;Yoshihiro Furuichi;T. Okubo;Tadamichi Kawano;T. Arai;Naoto Kawabe;N. Kawamura;T. Ikegami;M. Nakamuta;R. Shigefuku;M. Iwasa;Yasuhito Tanaka;Masaru Hatano;K. Iwakiri

超声心动图测量三尖瓣反流压力梯度（TRPG）是诊断门脉高压（PoPH）最客观的方法。本研究旨在确定与肝硬化患者的高TRPG相关的因素，并开发一个评分模型，用于识别患者谁是最有可能受益于超声心动图investigations.ResultsA共486例患者接受超声心动图随机分配的推导和验证集的比例为2：1。其中51例（10.5%）患者的TRPG ≥ 35 mmHg。中位脑钠肽（BNP）为39.5 pg/mL。91例（18.7%）患者报告了呼吸短促。在推导集中，多变量分析将女性、呼吸短促和BNP ≥ 48.9 pg/mL确定为TRPG ≥ 35 mmHg的独立因素。预测TRPG ≥ 35 mmHg的风险评分计算如下：− 3.596 + 1.250 ×性别（女性：1，男性：0）+1.093 × BNP（存在：1，不存在：0）+0.953 × BNP（≥ 48.9 pg/mL：1，<48.9 pg/mL：0）。风险评分预测TRPG ≥ 35 mmHg的敏感性为66.7%，特异性为75.3%，阳性预测值为25.5%，阴性预测值为94.3%，预测准确性为74.4%。这些结果是几乎相似的验证集，表明的重复性和有效性的风险scores.ConclusionsThis研究澄清了疑似PoPH患者的特点，并制定了一个评分模型，用于识别患者在高风险的PoPH，这可能是用于选择患者，可能受益于超声心动图。

BackgroundTricuspid regurgitation pressure gradient (TRPG) measurement by echocardiography is recommended as the most objective examination to detect portopulmonary hypertension (PoPH). This study aimed to identify factors associated with a high TRPG in patients with cirrhosis and develop a scoring model for identifying patients who are most likely to benefit from echocardiography investigations.ResultsA total of 486 patients who underwent echocardiography were randomly allocated to the derivation and validation sets at a ratio of 2:1. Of the patients, 51 (10.5%) had TRPG ≥ 35 mmHg. The median brain natriuretic peptide (BNP) was 39.5 pg/mL. Shortness of breath (SOB) was reported by 91 (18.7%) patients. In the derivation set, multivariate analysis identified female gender, shortness of breath, and BNP ≥ 48.9 pg/mL as independent factors for TRPG ≥ 35 mmHg. The risk score for predicting TRPG ≥ 35 mmHg was calculated as follows: − 3.596 + 1.250 × gender (female: 1, male: 0) + 1.093 × SOB (presence: 1, absence: 0) + 0.953 × BNP (≥ 48.9 pg/mL: 1, < 48.9 pg/mL: 0). The risk score yielded sensitivity of 66.7%, specificity of 75.3%, positive predictive value of 25.5%, negative predict value of 94.3%, and predictive accuracy of 74.4% for predicting TRPG ≥ 35 mmHg. These results were almost similar in the validation set, indicating the reproducibility and validity of the risk score.ConclusionsThis study clarified the characteristics of patients with suspected PoPH and developed a scoring model for identifying patients at high risk of PoPH, which may be used in selecting patients that may benefit from echocardiography.

Risk factors for portopulmonary hypertension in patients with cirrhosis: a prospective, multicenter study

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