Noninvasive prediction of clinically significant portal hypertension and esophageal varices in patients with compensated liver cirrhosis
Noninvasive prediction of clinically significant portal hypertension and esophageal varices in patients with compensated liver cirrhosis
复制标题
DOI：
10.1111/j.1572-0241.2008.01826.x
复制
发表时间：
2008-05-01
影响因子：
9.8
通讯作者：
Garcia-Pagan, Juan C.
中科院分区：
文献类型：
--
作者：
Berzigotti, Annalisa;Gilabert, Rosa;Garcia-Pagan, Juan C.
目的：我们旨在开发基于无创变量的模型，以预测具有补偿肝病的患者的临床上重要的门静脉高压（CSPH）和食管静脉曲张（EV）。在训练集中。所有患者均进行体格检查，实验室测试，腹部颜色多普勒超声检查，上消化道内窥镜检查以及肝静脉压力梯度的测量。计算了CSPH和EV的存在的预测模型。这些模型在74例具有补偿肝病的患者的独立系列中得到了验证。分析：在最终模型中选择了临床和实验室变量，而超声检查并未为预测CSPH和EV的预测增加统计能力。 CSPH预测的模型包括白蛋白，INR和ALT。最佳截止值在训练集中具有93％的敏感性和61％的特异性，并且在验证集中正确分类了77％的患者。蜘蛛血管瘤，ALT和白蛋白预测EV。训练组中该模型的最佳临界值的灵敏度为93％，特异性为37％，并且在验证集中正确分类了72％的病例。结论：在良好补偿的持续性病人中对EV的无创预测是不准确的。但是，通过组合简单的实验室变量获得的模型具有很高的灵敏度，可以预测该人群中的CSPH，并且可能有助于选择需要筛查内窥镜检查的患者子集。通过这种方法，大约40％的患者可以消除内窥镜检查。
OBJECTIVES: We aimed to develop a model based on noninvasive variables for the prediction of clinically significant portal hypertension (CSPH) and of esophageal varices (EV) in patients with compensated liver disease.METHODS: Sixty patients with compensated liver cirrhosis diagnosed by histology were included in the training set. All patients had physical examination, laboratory tests, abdominal color-Doppler ultrasound, upper digestive tract endoscopy, and measurement of hepatic venous pressure gradient. Predictive models for the presence of CSPH and of EV were calculated. The models were validated in an independent series of 74 patients with compensated liver disease.RESULTS: Clinical and laboratory variables were selected in the final models, while ultrasonography did not add statistical power for the prediction of CSPH and EV. The model for prediction of CSPH included albumin, INR, and ALT. The best cutoff had 93% sensitivity and 61% specificity in the training set, and correctly classified 77% of patients in the validation set. Spider angiomas, ALT, and albumin predicted EV. The best cutoff of the model in the training set had a sensitivity of 93% and a specificity of 37% and correctly classified 72% of cases in the validation set.CONCLUSIONS: Noninvasive prediction of EV in well-compensated cirrhotic patients is not accurate. However, a model obtained by combining simple laboratory variables has a high sensitivity to predict CSPH in this population and may be useful to select the subset of patients requiring screening endoscopy. By this method, endoscopic screening could be obviated in about 40% of patients.