■在肝静脉压力梯度(HVPG)估计以外的策略上存在有限的数据,以预测患有静脉曲张出血(VB)的肝硬化患者的未来事件,但在其他方面得到补偿。我们评估了VB发作期间的肝硬度测量(LSM)是否可以准确预测这种风险。
■在这项前瞻性研究中,在VB发作期间,以VB为指标的肝硬化患者连续接受HVPG和LSM评估。新发进一步失代偿事件(腹水,VB,脑病)在随访期间进行评估。将出血后LSM的性能特征与终末期肝病(MELD)评分和HVPG模型进行比较,以预测未来的代偿失调,并进行交叉验证。
■该队列(n=68)的平均年龄为44.2岁,酒精相关性肝病(55.9%)是最常见的病因。在14(9-18)个月的中位随访中,18例(26.4%)患者进一步代偿失调,腹水是最常见的事件。进一步失代偿的患者出血后LSM中位数较高[60.5kPa(53-70)与25kPa(18-34),P<0.001],HVPG[19mmHgvs.16mmHg,P=0.005],和MELD得分[12.5(11-14.7)vs.10(8-12)P<0.001]。出血后LSM的接受者-操作者特征曲线下面积[0.928(95CI:0.868-0.988)]高于两个HVPG[0.733(0.601-0.865),P=0.003]和MELD评分[0.776(0.664-0.889),P=0.019]预测进一步的失代偿。使用MELD和出血后LSM的乐观校正c统计量类似于HVPG的组合,MELD,和出血后LSM。
■出血后LSM在预测其他代偿性肝硬化患者的进一步代偿期事件方面与HVPG估计相当。
UNASSIGNED: Limited data exist on strategies other than hepatic venous pressure gradient (
HVPG) estimation to predict future events in patients with cirrhosis presenting with variceal bleed (VB) but are otherwise compensated. We assessed whether liver stiffness measurement (LSM) during VB episode could accurately predict this risk.
UNASSIGNED: Consecutive patients with cirrhosis with VB as their index decompensation event underwent
HVPG and LSM estimation during the VB episode in this prospective study. New onset further decompensation events (ascites, VB, encephalopathy) was assessed over follow-up. The performance characteristics of postbleed LSM were compared with model for end stage liver disease (MELD) score and
HVPG to predict future decompensation and were cross-validated.
UNASSIGNED: Mean age of the cohort (n = 68) was 44.2 years and alcohol-related liver disease (55.9%) was the most common etiology. Over a median follow-up of 14 (9-18) months, 18(26.4%) patients developed further decompensation with ascites being the most common event. Patients with further decompensation had a higher median postbleed LSM [60.5 kPa (53-70) vs. 25 kPa (18-34), P < 0.001],
HVPG [ 19 mm Hg vs. 16 mmHg, P = 0.005], and MELD score [ 12.5 (11-14.7) vs. 10 (8-12) P < 0.001]. The area under receiver-operator characteristics curve for postbleed LSM [0.928 (95%CI: 0.868-0.988)] was higher than both HVPG [0.733(0.601-0.865), P = 0.003] and MELD score [0.776(0.664-0.889), P = 0.019] to predict further decompensation. Optimism-corrected c-statistic using MELD and postbleed LSM was similar to a combination of
HVPG, MELD, and postbleed LSM.
UNASSIGNED: Postbleed LSM is comparable to HVPG estimation in predicting further decompensation events in patients with otherwise compensated cirrhosis presenting with VB.