在预测慢性肝病中需要治疗的静脉曲张的非侵入性工具中做

StephenW

Deciding Among Noninvasive Tools for Predicting Varices Needing Treatment in Chronic Liver Disease: An Analysis of Asian Cohort
Sanchit Sharma  1 , Samagra Agarwal  1 , Deepak Gunjan  1 , Kanav Kaushal  1 , Abhinav Anand  1 , Anoop Saraya  1
Affiliations
Affiliation

    1
    Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India.

    PMID: 32516202 DOI: 10.14309/ajg.0000000000000722

Abstract

Introduction: Both transient elastography (TE)-based and non-TE-based criteria exist for detection of varices needing treatment (VNT) in patients with asymptomatic advanced chronic liver disease (CLD). However, their performance in clinical settings at different risk thresholds of detection of VNT and in regions where elastography is not widely available is unknown. We aimed to validate existing noninvasive criteria in our patients with CLD and identify best TE- and non-TE-based criteria for VNT screening at usual risk thresholds.

Methods: Patients with compensated advanced CLD (cACLD) who underwent esophagogastroduodenoscopy and TE within 3 months were included. Diagnostic performance of Baveno VI, expanded Baveno VI, platelet-model for end-stage liver disease, and platelet-albumin (Rete Sicilia Selezione Terapia-hepatitis C virus) criteria were estimated. Decision curve analysis was conducted for different predictors across range of threshold probabilities. A repeat analysis including all patients with compensated CLD (cACLD and non-cACLD) was performed to simulate absence of TE.

Results: A total of 1,657 patients (cACLD, 895; non-cACLD, 762) related to hepatitis B virus (38.2%), hepatitis C virus (33.4%), nonalcoholic steatohepatitis (14.7%), and alcohol (11.8%) were included. Baveno VI identified maximum VNT (97.3%) and had best negative predictive value (96.9%), followed by platelet-albumin criteria. Expanded Baveno VI and platelet-model for end-stage liver disease had intermediate performance. At threshold probability of 5%, Baveno VI criteria showed maximum net benefit, and platelet-albumin criteria was next best, with need for 95 additional elastographies to detect 1 additional VNT. Similar results were obtained on including all patients with compensated CLD irrespective of TE.

Discussion: Baveno VI criteria maximizes VNT yield at 5% threshold probability. An acceptable alternative is the platelet-albumin criteria in resource-limited settings.

StephenW

在预测慢性肝病中需要治疗的静脉曲张的非侵入性工具中做出决定：亚洲队列分析
Sanchit Sharma 1，Samagra Agarwal 1，Deepak Gunjan 1，Kanav Kaushal 1，Abhinav Anand 1，Anoop Saraya 1
隶属关系
联系

    1个
    印度新德里全印度医学科学研究所胃肠病学和人类营养系。

    PMID：32516202 DOI：10.14309 / ajg.0000000000000722

抽象

简介：存在基于瞬态弹性成像（TE）和基于非TE的标准，可用于检测无症状晚期慢性肝病（CLD）患者的静脉曲张需要治疗（VNT）。但是，它们在临床环境中在检测VNT的不同风险阈值和弹性成像不广泛可用的区域中的表现尚不清楚。我们旨在验证CLD患者中现有的非侵入性标准，并在常规风险阈值下确定最佳的基于TE和基于非TE的VNT筛查标准。

方法：纳入了在3个月内接受食管胃十二指肠镜和TE的代偿性晚期CLD（cACLD）患者。评估了Baveno VI，扩展的Baveno VI，终末期肝病的血小板模型和血小板白蛋白（Rec Sicilia Selezione Terapia-C型肝炎病毒）标准的诊断性能。针对阈值概率范围内的不同预测变量进行了决策曲线分析。进行了包括所有补偿CLD患者（cACLD和非cACLD）的重复分析，以模拟TE的缺失。

结果：与乙型肝炎病毒（38.2％），丙型肝炎病毒（33.4％），非酒精性脂肪性肝炎（14.7％）和酒精（11.8％）相关的患者共1,657例（cACLD，895；非cACLD，762）。包括在内。 Baveno VI鉴定出最大的VNT（97.3％），并具有最佳的阴性预测值（96.9％），其次是血小板-白蛋白标准。晚期肝病的扩大的Baveno VI和血小板模型具有中等表现。在5％的阈值概率下，Baveno VI标准显示出最大的净收益，而血小板-白蛋白标准次之，需要另外进行95次弹性成像以检测另外1个VNT。包括所有患有补偿性CLD的患者，无论TE是否获得类似的结果。

讨论：Baveno VI标准以5％的阈值概率最大化VNT产量。可接受的替代方法是在资源有限的环境中使用血小板-白蛋白标准。