The Portal Hypertension Decompensation Score: A Validated Predictive Model of Liver Decompensation Related to Portal Hypertension.

IF 7.6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Angus W Jeffrey, Avik Majumdar, Gary Jeffrey, Luis Calzadilla-Bertot, Michael Wallace, Tim Mitchell, Yi Huang, John Joseph, George Garas, Wendy Cheng, Leon A Adams
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Abstract

Introduction: There is a need for noninvasive risk stratification in people with compensated advanced chronic liver disease (cACLD) to prognosticate and guide management. We aimed to develop a score that predicts decompensation in people with cACLD without the need for a liver stiffness measurement.

Methods: A multicenter state-wide cohort of patients with cACLD between 2004 and 2015 were followed until decompensation. A predictive score using serum markers was developed in a training cohort (n = 967) using competing risk analysis and internally validated (n = 417). Further external validation and comparison with other scores was undertaken in 315 patients between 2017 and 2024.

Results: Decompensation occurred in 172 (17.8%), 64 (15.3%), and 51 patients (16.2%) in the training and 2 validation cohorts ( P = 0.60) after median follow-up of 3.2, 3.4, and 1.9 years, respectively. Bilirubin, alanine aminotransferase, alkaline phosphatase, albumin, and platelets predicted decompensation and combined into a final model-the Portal Hypertension Decompensation Score (PDS). The PDS was well calibrated with good discrimination for predicting decompensation. In the 2 validation cohorts, accuracy (time-dependent area under the curve) of the PDS for predicting decompensation was high at 2 years (0.75 and 0.82) and 5 years (0.74 and 0.83). A low score (< -3.348) had a sensitivity of 74%-84% in prediction of no decompensation with a negative predictive value of 91%-95%, whereas a high score (> -2.828) was 87%-93% specific for future decompensation with a positive predictive value of 33%-58%.

Discussion: The PDS is an accurate predictor of decompensation in cACLD. It discriminates patients who are low risk from those who are high risk and who may benefit from further evaluation or treatment, without requiring the use of liver stiffness measurement.

门脉高压失代偿评分-门脉高压相关肝脏失代偿的有效预测模型。
背景和目的:代偿性晚期慢性肝病(cACLD)患者需要无创风险分层来预测和指导治疗。我们的目标是开发一种评分方法,在不需要肝硬度测量(LSM)的情况下预测cACLD患者的失代偿。方法:在2004-2015年期间对全国范围内的cACLD患者进行多中心队列随访,直至失代偿。在训练队列(n=967)中使用竞争风险分析和内部验证(n=417)开发了使用血清标记物的预测评分。在2017-2024年期间,对315名患者进行了进一步的外部验证和与其他评分的比较。结果:中位随访时间分别为3.2年、3.4年和1.9年,训练组和验证组分别有172人(17.8%)、64人(15.3%)和51人(16.2%)出现失代偿(p=0.60)。胆红素、丙氨酸转氨酶、碱性磷酸酶、白蛋白和血小板预测失代偿,并合并成最终模型-门脉高压失代偿评分(PDS)。PDS被很好地校准,对预测失代偿有很好的辨别能力。在两个验证队列中,PDS预测失代偿的准确性(时间依赖的AUC)在2年(0.75和0.82)和5年(0.74和0.83)时很高。低分(-2.828)对未来失代偿的特异性为87-93%,阳性预测值为33-58%。结论:PDS是cACLD失代偿的准确预测指标。它区分了低风险患者和高风险患者,哪些患者可能受益于进一步的评估或治疗,而不需要使用LSM。
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来源期刊
American Journal of Gastroenterology
American Journal of Gastroenterology 医学-胃肠肝病学
CiteScore
11.40
自引率
5.10%
发文量
458
审稿时长
12 months
期刊介绍: Published on behalf of the American College of Gastroenterology (ACG), The American Journal of Gastroenterology (AJG) stands as the foremost clinical journal in the fields of gastroenterology and hepatology. AJG offers practical and professional support to clinicians addressing the most prevalent gastroenterological disorders in patients.
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