Development of Clinical Algorithm Utilizing Vibration-Controlled Transient Elastography to Detect Advanced Hepatic Fibrosis in Liver Transplant Recipients.
Development of Clinical Algorithm Utilizing Vibration-Controlled Transient Elastography to Detect Advanced Hepatic Fibrosis in Liver Transplant Recipients.
复制标题
开发利用振动控制瞬态弹性成像检测肝移植受者晚期肝纤维化的临床算法。
DOI：
10.1007/s10620-024-08366-0
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发表时间：
2024
影响因子：
3.1
通讯作者：
Siddiqui,MohammadShadab
中科院分区：
文献类型：
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作者：
Arshad,Tamoore;Vainer,Dylan;Khan,Hiba;Baral,Alok;Garg,Shreya;Ang,Audrey;Patel,Vaishali;Kumaran,Vinay;Bruno,David;Lee,Seung;Sharma,Amit;Muthiah,Mark;Bui,AnhT;Siddiqui,MohammadShadab
基于振动控制瞬时弹性成像（VCTE）的肝脏硬度测量（LSM）是肝移植（LT）受者中晚期肝纤维化的一种极好的“排除”测试，然而，其“纳入”疾病的能力并不理想。本研究旨在提高LSM在LT recipients.Methodsadult LT受体与肝活检和VCTE的诊断性能被列入（N= 150）。结果LSM < 7.45 kPa（n= 72）或7.45 ≤ LSM < 12.1 kPa且LT时间< 5.6年（n= 25）的患者排除了晚期肝纤维化。相反，如果患者LSM > 14.1且受控衰减参数> 279 dB/m，则晚期纤维化的可能性为95%（n= 21）。因此，118例（79%）被正确识别，32例（21%）需要活检才能确诊。与先前建立的基于LSM的临界值10.5 kPa（Youden指数）和13.3 kPa（最大特异性）相比，序贯覆盖分析的假阳性率为1%，而LSM ≥ 10.5 kPa为16.5%，LSM ≥ 13.3 kPa为8.3%。序列覆盖分析的真阳性率为87%，LSM ≥ 10.5 kPa为93%，LSM ≥ 13.3 kPa.ConclusionThe建议的临床序列覆盖分析允许更好的风险分层时，评估晚期肝纤维化在LT收件人相比，单独LSM。有必要做出额外的努力，以进一步减少可能需要肝活检的结果不确定的患者数量。
IntroductionVibration-controlled transient elastography (VCTE) based liver stiffness measurement (LSM) is an excellent ‘rule-out’ test for advanced hepatic fibrosis in liver transplant (LT) recipients, however, its ability to ‘rule-in’ the disease is suboptimal. The study aimed to improve diagnostic performance of LSM in LT recipients.MethodsAdult LT recipients with a liver biopsy and VCTE were included (N= 150). Sequential covering analysis was performed to create rules to identify patients at low or high risk for advanced fibrosis (stage 3–4).ResultsAdvanced hepatic fibrosis was excluded in patients with either LSM < 7.45 kPa (n= 72) or 7.45 ≤ LSM < 12.1 kPa and time from LT < 5.6 years (n= 25). Conversely, likelihood of advanced fibrosis was 95% if patients had LSM > 14.1 and controlled attenuation parameter > 279 dB/m (n= 21). Thus, 118 (79%) were correctly identified and 32 (21%) would have required a biopsy to establish the diagnosis. Compared to previously established LSM based cutoff values of 10.5 kPa (Youden index) and 13.3 kPa (maximized specificity), the false positive rates of sequential covering analysis was 1% compared to 16.5% with LSM ≥ 10.5 kPa and 8.3% with LSM ≥ 13.3 kPa. The true positive rates were comparable at 87% for sequential covering analysis, 93% for LSM ≥ 10.5 kPa and 83% for LSM ≥ 13.3 kPa.ConclusionThe proposed clinical sequential covering analysis allows for better risk stratification when evaluating for advanced fibrosis in LT recipients compared to LSM alone. Additional efforts are necessary to further reduce the number of patients with indeterminate results in whom a liver biopsy may be required.