评估直接作用抗病毒药物治疗的 HCV 相关肝炎患者肝纤维化和死亡率的预测指标 LiverRisk 评分

IF 4 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive and Liver Disease Pub Date : 2024-09-01 DOI:10.1016/j.dld.2024.08.015

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引用次数: 0

摘要

导言肝脏风险评分（LiverRisk score）是最近开发出来的一种预测肝纤维化和肝脏相关预后的指标，已在普通人群中得到验证。本研究旨在评估 LiverRisk 评分作为直接作用抗病毒药物（DAA）治疗的 HCV 相关肝炎患者肝纤维化和死亡率预测指标的作用。方法回顾性纳入 2015 年至 2017 年期间接受 DAA 治疗的慢性丙型肝炎门诊患者。患者随访至 2023 年 9 月。排除标准为：在DAAs之前接受过肝移植以及存在HCC。在开始使用 DAA 之前，收集了患者的特征和 LiverRisk 评分。计算肝脏风险评分的数据是在进行纤维扫描的当天收集的。主要终点是肝脏硬度≥10 kPa。接受者操作特征曲线下面积（AUROC）用于评估肝脏风险评分的判别能力。结果在这项正在进行的研究中，我们中心共纳入了136名接受DAA治疗的慢性丙型肝炎患者。其中，51%为男性，平均年龄为（65.3±12.2）岁，65.4%为基因型1，59.6%为肝硬化，平均肝硬度测量值为15.9 KPa (3.5-48.8)，持续病毒学应答（SVR）为95.5%，平均随访时间为59个月。8.8%的患者合并乙型肝炎病毒（HBV）感染。AUROC 为 0.848（95% 置信区间 [CI] = 0.767-0.930；P=0.000），表明肝脏风险评分在预测肝脏硬度≥10KPa 方面具有很好的鉴别能力。在随访期间，21 名患者（15.4%）死亡。肝脏风险评分与所有死亡原因的风险相关（危险比 = 1.154; 95% CI = 1.01-1.318; p = 0.035）。

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Evaluation of LiverRisk score as predictor of liver fibrosis and mortality in patients with HCV-related hepatitis treated with direct acting antivirals

Introduction

The LiverRisk score has been recently developed and validated as a predictor of liver fibrosis and liver-related outcomes in the general population. This score has never been evaluated as predictor of liver fibrosis and outcomes in secondary care, such as in patients with chronic liver diseases.

AIM

The aim of this study was to evaluate the role of the LiverRisk score as a predictor of liver fibrosis and mortality in patients with HCV-related hepatitis treated with direct acting antivirals (DAA).

Methods

patients were enrolled retrospectively, outpatients with chronic hepatitis C treated with DAA between 2015 and 2017 were included consecutively. Patients were followed-up until September 2023. The exclusion criteria were: liver transplantation before DAAs and presence of HCC. Patient characteristics and LiverRisk score were collected before starting the DAA. The data for the calculation of LiverRisk score were collected the same day the fibroscan was performed. The primary endpoint was a liver stiffness ≥10 kPa. Area under the receiver operating characteristic (AUROC) curve was evaluated for assessing the discrimination ability of Liver Risk score. Overall mortality was assessed at the end of follow-up.

Results

in this ongoing study, 136 patients of our center with chronic hepatitis C treated with DAA were enrolled. In this population, 51% were men, the mean age was 65.3±12.2 years, 65.4% were genotype 1, 59.6% had liver cirrhosis, the mean liver stiffness measurement was 15.9 KPa (3.5-48.8), sustained virological response (SVR) was 95.5% and the mean follow-up was of 59 months. Coinfection with hepatitis B virus (HBV) was present in 8.8%. Discrimination ability of the LiverRisk score in the prediction of liver stiffness ≥10KPa was very good as shown by an AUROC of 0.848 (95% confidence interval [CI] = 0.767-0.930; p=0.000). During follow up 21 patients (15.4%) died. LiverRisk score was associated with the risk of all cause of mortality (Hazard Ratio = 1.154; 95% CI = 1.01–1.318; p = 0.035).

Conclusion

the liver risk score is a good predictor of fibrosis and mortality in HCV patients treated with DAA.

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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.