无创检查可识别出可以避免内窥镜检查的肝硬化患者

StephenW

Noninvasive test identifies patients with cirrhosis who can avoid endoscopy

Kew GS, et al. Clin Gastroenterol Hepatol. 2019;doi:10.1016/j.cgh.2019.11.015.
December 10, 2019

Application of a novel noninvasive test comprised of albumin, bilirubin and platelets successfully identified patients with cirrhosis who could safely avoid screening endoscopy without the need for liver stiffness measurements by transient elastography compared with the Baveno VI criteria, according to a published study.

“As TE is not widely available, the Baveno VI criteria could not be applied in many clinical settings,” Guan Sen Kew, MD, from the National University Health System in Singapore, and colleagues wrote. “As such, we aim to determine a concise clinical criterion as an alternative noninvasive tool to predict absence of [high-risk varices] among patients with compensated cirrhosis to avoid screening esophagogastroduodenoscopy (EGD).”
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The multi-ethnic Asian cohort comprised 352 patients, most of whom were Chinese (68.5%). High-risk varices were present on EGD in 56 patients and 120 patients met the Baveno VI criteria.

Multivariable analysis revealed that an albumin level of 40 g/dL or less (HR = 2.65; 95% CI, 1.34-5.24), bilirubin of 22 µmol/L or more (HR = 2.7; 95% CI, 1.38-5.26), and platelet count of 114,000 µL or less (HR = 3.88; 95% CI, 2.03-7.41) predicted high-risk varices. Application of this “ABP” criteria identified 110 patients, only two of whom had high-risk varices.

The area under the receiver operating characteristic curve (AUROC) of the ABP criteria was slightly higher than the Baveno VI (0.78 vs. 0.73), and the two criteria had similar sensitivity (96% vs. 93%), specificity (36% vs. 39%), positive predictive value (both 22%), and negative predictive value (98% vs. 97%).

“Identification of patients with low probability of having [high-risk varices] is essential to reduce the number of screening EGD with its associated cost and risks,” Kew and colleagues wrote. “Components of our novel ABP criteria, namely serum albumin, serum bilirubin and platelet count, are standard laboratory tests readily available and routinely performed in clinical practice.”

The researchers concluded that prospective validation of this noninvasive criteria should be tested in other populations to confirm its utility. – by Talitha Bennett

Disclosures: The authors report no relevant financial disclosures.

StephenW

无创检查可识别出可以避免内窥镜检查的肝硬化患者

Kew GS等。 Castro Gastroenterol Hepatol。 2019; doi：10.1016 / j.cgh.2019.11.015。
2019年12月10日

根据一项已发表的研究，采用包含白蛋白，胆红素和血小板的新型无创检测技术，成功地鉴定出了肝硬化患者，他们可以安全地避免筛查内窥镜，而无需通过瞬时弹性成像与Baveno VI标准进行肝硬度测量。

新加坡国立大学卫生系统的医学博士关森·邱及其同事写道：“由于TE尚不广泛，因此Baveno VI标准无法在许多临床环境中应用。” “因此，我们旨在确定一种简洁的临床标准，作为可预测的肝硬化患者中不存在[高风险静脉曲张]的另一种非侵入性工具，以避免筛查食管胃十二指肠镜（EGD）。”
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多种族的亚洲队列包括352名患者，其中大多数是中国人（68.5％）。有56例患者的EGD存在高风险静脉曲张，其中120例患者符合Baveno VI标准。

多变量分析显示白蛋白水平为40 g / dL或更低（HR = 2.65; 95％CI，1.34-5.24），胆红素为22μmol/ L或更高（HR = 2.7; 95％CI，1.38-5.26），血小板计数为114,000 µL或更低（HR = 3.88； 95％CI，2.03-7.41）可预测高风险静脉曲张。应用该“ ABP”标准可确定110例患者，其中只有2例具有高风险静脉曲张。

ABP标准的接收器工作特征曲线（AUROC）下的面积略高于Baveno VI（0.78 vs. 0.73），并且两个标准具有相似的灵敏度（96％vs. 93％），特异性（36％vs.36％）。 39％），阳性预测值（均为22％）和阴性预测值（分别为98％和97％）。

Kew和同事写道：“对具有[高风险静脉曲张]可能性低的患者进行识别，对于减少筛查EGD及其相关的成本和风险至关重要。” “我们新的ABP标准的组成部分，即血清白蛋白，血清胆红素和血小板计数，是易于获得的标准实验室测试，并在临床实践中常规进行。”

研究人员得出结论，应在其他人群中对该无创标准进行前瞻性验证，以确认其实用性。 –塔利莎·贝内特（Talitha Bennett）

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