Validation of a Model for Identification of Patients With Compensated Cirrhosis at High Risk of Decompensation
Validation of a Model for Identification of Patients With Compensated Cirrhosis at High Risk of Decompensation
复制标题
DOI：
10.1016/j.cgh.2019.01.042
复制
发表时间：
2019-10-01
影响因子：
12.6
通讯作者：
Johnson, Philip J.
中科院分区：
文献类型：
--
作者：
Guha, Indra Neil;Harris, Rebecca;Johnson, Philip J.
背景与目的：快速识别晚期肝病患者非常重要。评估肝功能和纤维化的常规检查提供了可用于确定患者病情的数据。我们测试了验证的能力，从ALBI和FIB-4评分系统相结合的数据，以确定代偿性肝硬化患者在失代偿的最高风险。METHODS：我们收集了145例代偿性肝硬化（91%的儿童A型肝硬化和MELD评分中位数低于8）从队列在诺丁汉，英国，随后为中位数4.59年（发展队列）的数据。我们收集基线临床特征并记录失代偿事件。我们使用这些数据开发了一个基于肝功能（通过ALBI评分评估）和纤维化程度（通过FIB-4指数评估）的模型，以确定失代偿的风险。我们验证了该模型在2个独立的外部队列（1在都柏林，爱尔兰和1在Menoufia，埃及），包括234 patients.RESULTS：在发展队列，19.3%的患者发展失代偿期肝硬化。使用ALBI和FIB-4评分的组合，我们开发了一个模型，用于识别失代偿低风险与高风险的患者（高风险评分患者失代偿的风险比[HR]为7.10）。当我们在验证队列中测试评分系统时，在爱尔兰队列中具有高风险评分的患者中失代偿的HR为12.54，在Egyptiancohol.CONCLUSION中为5.10：我们开发了基于ALBI和FIB-4评分组合的评分系统，该系统可识别具有肝失代偿风险的患者。我们在2个独立的国际队列（欧洲和中东）中验证了评分系统，因此它似乎适用于不同的人群。
BACKGROUND & AIMS: It is important to rapidly identify patients with advanced liver disease. Routine tests to assess liver function and fibrosis provide data that can be used to determine patients' prognoses. We tested the validated the ability of combined data from the ALBI and FIB-4 scoring systems to identify patients with compensated cirrhosis at highest risk for decompensation.METHODS: We collected data from 145 patients with compensated cirrhosis (91% Child A cirrhosis and median MELD scores below 8) from a cohort in Nottingham, United Kingdom, followed for a median 4.59 years (development cohort). We collected baseline clinical features and recorded decompensation events. We used these data to develop a model based on liver function (assessed by the ALBI score) and extent of fibrosis (assessed by the FIB-4 index) to determine risk of decompensation. We validated the model in 2 independent external cohorts (1 in Dublin, Ireland and 1 in Menoufia, Egypt) comprising 234 patients.RESULTS: In the development cohort, 19.3% of the patients developed decompensated cirrhosis. Using a combination of ALBI and FIB-4 scores, we developed a model that identified patients at low vs high risk of decompensation (hazard ratio [HR] for decompensation in patients with high risk score was 7.10). When we tested the scoring system in the validation cohorts, the HR for decompensation in patients with a high-risk score was 12.54 in the Ireland cohort and 5.10 in the Egypt cohort.CONCLUSION: We developed scoring system, based on a combination of ALBI and FIB-4 scores, that identifies patients at risk for liver decompensation. We validated the scoring system in 2 independent international cohorts (Europe and the Middle East), so it appears to apply to diverse populations.