脾脏面积影响基于血小板计数的无创工具对 MASLD 相关性肝硬化失代偿的预测性能:初步观察结果

IF 4 3区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Digestive and Liver Disease Pub Date : 2024-09-01 DOI:10.1016/j.dld.2024.08.019
M. Dallio, M. Romeo, F. Di Nardo, P. Vaia, C. Napolitano, C. Basile, S. Olivieri, L. Vitale, M. Niosi, A. Federico
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引用次数: 0

摘要

导言几乎所有现有的非侵入性工具(NIT)都将血小板(PLT)计数作为预测晚期慢性肝病(ACLD)首次肝功能失代偿(FHD)的重要依据。然而,在代谢功能障碍相关性脂肪性肝病(MASLD)相关的 ACLD 患者中,有不可忽视的一部分人在出现临床上明显的门静脉高压(CSPH)时并没有表现出脾脏肿大和脾功能亢进相关的血小板减少。材料与方法在2018年至2021年期间,纳入了148名脾脏和27名脾脏(25名脾切除;2名起源)非选择性β受体阻滞剂(NSBB)无效的内镜下CSPH的MASLD-cACLD患者。患者随后接受了非选择性β受体阻滞剂治疗,并根据现有指南对反应进行了代理评估。超声人工智能支持的专用工具自动定义脾脏直径和脾脏面积(SA),区分 "脾大+"(91 例)和 "脾大-"(57 例)患者。每半年对患者进行一次观察,并记录与肝脏相关的事件。在基线和随访期间测定白蛋白-胆红素(ALBI)评分和结合 NIT 的 PLT 计数(PINs)[FIB-4、ALBI-FIB-4、红细胞分布宽度/PLT-比率、肝脏硬度测量/PLT-比率和 ANTICIPATE±NASH]。结果18.68%的 "脾肿大+"、19.29%的 "脾肿大-"和 22.22%的 "脾功能不全 "患者发生了急性肾功能衰竭。多变量竞争风险分析(已对性别、年龄、体重指数、糖尿病、MELD 和 NSBB 反应进行调整)显示,PINs 对 FHD 的预测作用不大,突出显示 SA 是与这一结果相关性更显著的变量 [aSHR: 0.870(95% C.I.:0.833-1.108),p<0.0001],而 ALBI [aSHR:1.273 (95% C.I.:1.199-1.305,p:0.002] 是 "脾大 "组中唯一显著的预测因素。同样,与 "脾大+"组相反,在 "脾大-"组和 "脾大 "组中,ROC 和时间依赖性 ROC 分析表明 PINs 在基线、1、1.结论 脾脏面积会显著影响 PINs 对 CSPH-MASLD-cACLD 患者的预测性能。
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Spleen area affects the predictive performance for decompensation of the platelet count-based non-invasive tools in MASLD-related cirrhosis: a preliminary observation

Introduction

The platelet (PLT) count is paramount in almost all the available non-invasive tools (NITs) predicting the first hepatic decompensation (FHD) in advanced chronic liver disease (ACLD). However, a non-negligible proportion of Metabolic dysfunction-associated Steatotic Liver Disease (MASLD)-related ACLD individuals presenting clinically significant portal hypertension (CSPH) do not show splenomegaly and hypersplenism-related thrombocytopenia.

Aim

To evaluate the performance of NITs in predicting the 3-year FHD in CSPH-MASLD-cACLD, stratifying the study population according to the splenomegaly.

Materials and Methods

Between 2018 and 2021, 148 splenic and 27 asplenic (25-splenectomized; 2-agenesis) nonselective-beta-blockers-(NSBB)-naïve MASLD-cACLD patients with endoscopic CSPH were enrolled. Patients subsequently received NSBBs and the response was surrogately evaluated following the available guidelines. Ultrasound AI-supported dedicated tools automatically defined spleen diameter and spleen area (SA), discriminating “Splenomegaly +” (91) and “Splenomegaly -” (57) patients. Patients were semiannually observed and the liver-related events were recorded. Albumin-bilirubin (ALBI) score and PLT count-incorporating NITs (PINs) [FIB-4, ALBI-FIB-4, red-cell-distribution-width/PLT-ratio, Liver-Stiffness-Measurement/PLT-ratio, and ANTICIPATE±NASH] were determined at baseline and during the follow-up.

Results

FHD occurred in 18.68% of “Splenomegaly+”, 19.29% of “Splenomegaly-”, and 22.22% of “Asplenic” individuals. The multivariate competing risk analysis (adjusted for sex, age, BMI, diabetes, MELD, and NSBB-response) revealed the PINs as modest predictors of FHD, highlighting SA as the variable more significantly associated with this outcome [aSHR: 0.870 (95% C.I.: 0.833-1.108), p<0.0001] in “Splenomegaly -”, and ALBI [aSHR:1.273 (95% C.I.:1.199-1.305, p:0.002] as the only significantly predicting factors in the “Asplenic” group. Consistently, contrariwise to “Splenomegaly +”, in “Splenomegaly -” and “Asplenic” individuals, ROC and time-dependent ROC analysis evidenced the poor performance of PINs in predicting HD at baseline, 1,1.5, and 2 years, evidencing only ALBI preserved a good accuracy (baseline AUC 0.651, p:0.04 and baseline AUC:0.625, p:0.03 respectively) (Figure).

Conclusions

The spleen area dramatically affects the predictive performance of the PINs in CSPH-MASLD-cACLD patients.

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来源期刊
Digestive and Liver Disease
Digestive and Liver Disease 医学-胃肠肝病学
CiteScore
6.10
自引率
2.20%
发文量
632
审稿时长
19 days
期刊介绍: Digestive and Liver Disease is an international journal of Gastroenterology and Hepatology. It is the official journal of Italian Association for the Study of the Liver (AISF); Italian Association for the Study of the Pancreas (AISP); Italian Association for Digestive Endoscopy (SIED); Italian Association for Hospital Gastroenterologists and Digestive Endoscopists (AIGO); Italian Society of Gastroenterology (SIGE); Italian Society of Pediatric Gastroenterology and Hepatology (SIGENP) and Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD). Digestive and Liver Disease publishes papers on basic and clinical research in the field of gastroenterology and hepatology. Contributions consist of: Original Papers Correspondence to the Editor Editorials, Reviews and Special Articles Progress Reports Image of the Month Congress Proceedings Symposia and Mini-symposia.
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