Hepatic venous pressure gradient (HVPG)-3P score as predictor tool of endoscopic signs of portal hypertension and liver-related events in patients with advanced chronic liver disease

IF 4 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive and Liver Disease Pub Date : 2024-09-01 DOI:10.1016/j.dld.2024.08.008

M. Capasso , M.R. Attanasio , V. Cossiga , A. Paccagnella , L. Ranieri , L. Schiadà , G. Scandali , G. Svegliati-Baroni , F. Morisco

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引用次数: 0

Abstract

Background

Clinically significant portal hypertension (CSPH) in patients with advanced chronic liver disease (ACLD) is high-risk condition for liver-related events (LRE). According with BAVENO VII, non-invasive tests (NIT) should be preferred to rule in or out for CSPH to avoid endoscopy. The novel score HVPG-3Parameters gave a prediction of HVPG showing good accuracy in CSPH prediction.

Aim

Aim is to evaluate the ability of HVPG-3P in PH and LRE prediction.

Methods

A retrospective study was conducted in two different Italian centers: University of Naples and University of Marche. In 10 years, consecutive compensated-ACLD patients who underwent upper-GI endoscopy for PH assessment were enrolled. NIT (FIB-4,ANTICIPATE,PLT/spleen-diameter ratio and HVPG-3P) were calculated. During the follow-up any LRE were recorded.

Results

Two-hundred and ninety-one ACLD subjects (with no differences between centers) were recruited (62.1% males, mean age 60 years).

Mean LSM was 23.6±11.7kPa; HVPG-3P was 13.3±2.0mmHg, ANTICIPATE was 1.0±1.6, FIB-4 was 5.0±3.2, platelets/spleen-diameter ratio was 906.5±568.2.

One-hundred and forty-two (48,9%) subjects showed PH endoscopic signs. They had higher LSM (26.6±12.4vs20.8±10.3kPa, p=0.00002), HVPG-3P (14.2±1.6vs12.4±2.0mmHg, p<0.001), ANTICIPATE (1.66±1.4vs0.31±1.5, p<0.001), FIB-4 (5.87±3.28vs4.13±2.84, p=0.001) and lower platelets/spleen-diameter ratio (652.4±323.6vs1148.6±641.8, p<0.0001) compared to subjects without PH endoscopic signs.

During a median follow-up of 41.5months (IQR 17.8-74.0) LRE occurred in a median of 18.9months (IQR 7.5-37) in 126/291 (43.2%).

Patients who experienced LRE showed higher LSM (26.0±12.3 vs21.9±11.0kPa, p=0.003), HVPG-3P (14.1±1.7vs12.6±2.0mmHg, p<0.0001), ANTICIPATE (1.54±1.57vs0.55±1.56, p<0.0001), FIB-4 (6.02±3.36vs4.19±2.79, p<0.0001) and lower platelets/spleen-diameter ratio (694.9±385.7vs1068.0±630.0, p<0.0001).

The HVPG-3P seems to have a good performance in PH and LRE prediction (considering the results from Random Forest model: MDA 4.52 and 6.55, higher than the majority of variables).

Conclusions

HVPG-3P is a simple tool for non-invasive prediction of PH and could be used to stratify the risk of LRE in patients with ACLD. However, this score needs to be validated in larger cohorts.

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肝静脉压力梯度（HVPG）-3P 评分作为晚期慢性肝病患者门静脉高压内镜征兆和肝脏相关事件的预测工具

背景晚期慢性肝病（ACLD）患者中有临床意义的门静脉高压（CSPH）是发生肝脏相关事件（LRE）的高危因素。根据 BAVENO VII，应首选无创检查（NIT）来排除或排除 CSPH，以避免内镜检查。新评分 HVPG-3Parameters 预测的 HVPG 在 CSPH 预测中显示出良好的准确性：那不勒斯大学和马尔凯大学。10 年间，连续接受上消化道内窥镜检查以评估 PH 的代偿性 ACLD 患者被纳入研究。计算了NIT（FIB-4、ANTICIPATE、PLT/脾脏直径比和HVPG-3P）。结果招募了 291 名 ACLD 受试者（各中心之间无差异）（62.1% 为男性，平均年龄 60 岁）。平均 LSM 为（23.6±11.7）kPa；HVPG-3P 为（13.3±2.0）mmHg；ANTICIPATE 为（1.0±1.6）；FIB-4 为（5.0±3.2）；血小板/脾脏直径比为（906.5±568.2）。他们的 LSM（26.6±12.4vs20.8±10.3kPa，p=0.00002）、HVPG-3P（14.2±1.6vs12.4±2.0mmHg，p<0.001）、ANTICIPATE（1.66±1.4vs0.31±1.5，p<0.001）、FIB-4（5.87±3.28vs4.13±2.84，p=0.001）和较低的血小板/脾脏直径比（652.在中位随访41.5个月（IQR 17.8-74.0）期间，126/291（43.2%）例患者在中位18.9个月（IQR 7.5-37）时发生LRE。发生LRE的患者LSM（26.0±12.3 vs21.9±11.0kPa，p=0.003）、HVPG-3P（14.1±1.7vs12.6±2.0mmHg，p<0.0001）、ANTICIPATE（1.54±1.57vs0.55±1.56，p<0.0001）、FIB-4（6.02±3.36vs4.19±2.HVPG-3P似乎在PH和LRE预测方面有很好的表现（考虑到随机森林模型的结果：结论HVPG-3P 是一种无创预测 PH 的简单工具，可用于对 ACLD 患者的 LRE 风险进行分层。然而，该评分需要在更大的队列中进行验证。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Digestive and Liver Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

2.20%

发文量

632

审稿时长

19 days

期刊介绍： Digestive and Liver Disease is an international journal of Gastroenterology and Hepatology. It is the official journal of Italian Association for the Study of the Liver (AISF); Italian Association for the Study of the Pancreas (AISP); Italian Association for Digestive Endoscopy (SIED); Italian Association for Hospital Gastroenterologists and Digestive Endoscopists (AIGO); Italian Society of Gastroenterology (SIGE); Italian Society of Pediatric Gastroenterology and Hepatology (SIGENP) and Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD). Digestive and Liver Disease publishes papers on basic and clinical research in the field of gastroenterology and hepatology. Contributions consist of: Original Papers Correspondence to the Editor Editorials, Reviews and Special Articles Progress Reports Image of the Month Congress Proceedings Symposia and Mini-symposia.