预测慢性乙型肝炎病毒感染临床事件的风险评分系统：一项

StephenW

预测慢性乙型肝炎病毒感染临床事件的风险评分系统：一项全国性队列研究
Ae Jeong Jo 1 , Won-Mook Choi 2 , Hyo Jeong Kim 1 , So Hyun Choi 1 3 , Seungbong Han 4 , Min Jung Ko 1 , Young-Suk Lim 2
隶属关系
隶属关系

    1
    大韩民国首尔国家循证医疗合作机构医疗技术评估研究部。
    2
    韩国首尔蔚山大学医学院牙山医学中心消化内科肝脏中心。
    3
    韩国大邱庆北国立大学统计系。
    4
    韩国首尔高丽大学医学院生物统计学系。

    PMID：34762757 DOI：10.1111/jvh.13631

抽象的

许多慢性乙型肝炎患者没有得到足够的随访。本研究旨在开发一个风险评分来预测人群水平的慢性乙型肝炎病毒 (HBV) 感染患者的临床事件，以识别高危患者以保证定期随访。本研究分析了 2005 年至 2015 年期间获得的韩国全国索赔数据库中基于人群的数据。我们确定了 507,239 名未接受抗病毒治疗的慢性 HBV 感染非肝硬化患者。用于预测临床事件（肝细胞癌、死亡或肝移植）的风险评分是基于开发队列（n = 401,745）中的多变量 Cox 比例风险模型开发的，并在验证队列（n = 105,494）中进行了验证。在开发和验证队列中，5 年临床事件的累积发生率分别为 2.56% 和 2.44%。根据年龄、性别、社会经济地位、慢性丙型肝炎合并感染、糖尿病、他汀类药物或抗血小板药物暴露、吸烟、饮酒、丙氨酸氨基转移酶和 γ-谷氨酰转移酶在开发和验证队列中都具有良好的区分准确性（3、5、10 年风险预测的 c 指数：均为 0.786）。在两个队列中校准了临床事件的预测和观察概率。 > 3.5 分的分数确定了处于明显高风险的受试者。使用易于获取的变量的 CAP-B 评分可以预测临床事件，并可以选择慢性 HBV 感染患者进行定期随访。

关键词：死亡；肝细胞癌;肝移植；国民健康保险数据库；风险预测。

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StephenW

A risk scoring system to predict clinical events in chronic hepatitis B virus infection: a nationwide cohort study
Ae Jeong Jo  1 , Won-Mook Choi  2 , Hyo Jeong Kim  1 , So Hyun Choi  1   3 , Seungbong Han  4 , Min Jung Ko  1 , Young-Suk Lim  2
Affiliations
Affiliations

    1
    Division for Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, Republic of Korea.
    2
    Liver Center, Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
    3
    Department of Statistics, Kyungpook National University, Daegu, Republic of Korea.
    4
    Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea.

    PMID: 34762757 DOI: 10.1111/jvh.13631

Abstract

Many patients with chronic hepatitis B do not receive adequate follow-up. This study aimed to develop a risk score to predict clinical events in patients with chronic hepatitis B virus (HBV) infection at the population level for identifying patients at high-risk to warrant regular follow-up. This study analyzed population-based data from the nationwide claims database of South Korea obtained between 2005 and 2015. We identified 507,239 non-cirrhotic patients with chronic HBV infection who are not under antiviral treatment. A risk score for predicting clinical events (hepatocellular carcinoma, death, or liver transplantation) was developed based on multivariable Cox proportional hazard model in a development cohort (n = 401,745) and validated in a validation cohort (n = 105,494). The cumulative incidence rates of clinical events at 5 years were 2.56% and 2.44% in the development and validation cohorts, respectively. Clinical events in Asymptomatic Patients with chronic HBV infection (CAP-B) score ranging from 0 to 7.5 points based on age, sex, socioeconomic status, chronic hepatitis C co-infection, diabetes mellitus, statin or antiplatelet exposure, smoking, alcohol consumption, alanine aminotransferase, and gamma-glutamyltransferase had good discriminatory accuracy in both the development and validation cohorts (c-indices for 3-, 5-, 10-year risk prediction: all 0.786). The predicted and observed probabilities of clinical events were calibrated in both cohorts. A score of >3.5 points identified subjects at distinctly high risk. The CAP-B score using easily accessible variables can predict clinical events and may allow selection of patients with chronic HBV infection for priority of regular follow-up.

Keywords: Death; Hepatocellular carcinoma; Liver transplantation; National Health Insurance Database; Risk prediction.

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