背景:为患者提供接受治愈性经颈静脉肝内门体分流术(TIPS)的机会,而不是对门脉高压相关的静脉曲张出血和腹水的姑息性治疗,我们旨在评估肝相关血管形态改变,以提高对明显肝性脑病(HE)风险的预测准确性.
方法:在这项多中心研究中,621名接受TIPS的患者被细分为培训(来自3家医院的413例)和外部验证数据集(来自另外3家医院的208例)。除了传统的临床因素,我们使用最大直径(包括绝对值和比值)评估肝脏相关血管形态变化.三种预测模型(临床,肝相关血管,并结合)使用逻辑回归构建。比较了它们的辨别和校准,以测试肝相关血管评估的必要性并确定最佳模型。此外,为了验证ModelC-V的改进性能,我们将它与以前的四种型号进行了比较,在辨别和校准方面。
结果:组合模型优于临床和肝相关血管模型(训练:0.814、0.754、0.727;验证:0.781、0.679、0.776;p<0.050),并且具有最佳校准。与以前的型号相比,ModelC-V在辨别方面表现优异。高,middle-,低危人群显示明显不同的HE发生率(p<0.001)。尽管TIPS前氨预测明显HE风险的能力有限,组合模型显示出令人满意的预测显性HE风险的能力,在低氨和高氨亚组。
结论:肝相关血管评估提高了显性HE的预测准确性,通过TIPS确保合适患者的治愈机会,并为肝硬化相关研究提供见解。
BACKGROUND: To provide patients the chance of accepting curative transjugular intrahepatic portosystemic shunt (TIPS) rather than palliative treatments for portal hypertension-related variceal bleeding and ascites, we aimed to assess hepatic-associated vascular morphological change to improve the predictive accuracy of overt hepatic encephalopathy (HE) risks.
METHODS: In this multicenter study, 621 patients undergoing TIPS were subdivided into training (413 cases from 3 hospitals) and external validation datasets (208 cases from another 3 hospitals). In addition to traditional clinical factors, we assessed hepatic-associated vascular morphological changes using maximum diameter (including absolute and ratio values). Three predictive models (clinical, hepatic-associated vascular, and combined) were constructed using logistic regression. Their discrimination and calibration were compared to test the necessity of hepatic-associated vascular assessment and identify the optimal model. Furthermore, to verify the improved performance of ModelC-V, we compared it with four previous models, both in discrimination and calibration.
RESULTS: The combined model outperformed the clinical and hepatic-associated vascular models (training: 0.814, 0.754, 0.727; validation: 0.781, 0.679, 0.776; p < 0.050) and had the best calibration. Compared to previous models, ModelC-V showed superior performance in discrimination. The high-, middle-, and low-risk populations displayed significantly different overt HE incidence (p < 0.001). Despite the limited ability of pre-TIPS ammonia to predict overt HE risks, the combined model displayed a satisfactory ability to predict overt HE risks, both in the low- and high-ammonia subgroups.
CONCLUSIONS: Hepatic-associated vascular assessment improved the predictive accuracy of overt HE, ensuring curative chances by TIPS for suitable patients and providing insights for cirrhosis-related studies.