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
{"title":"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","authors":"","doi":"10.1016/j.dld.2024.08.019","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p>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.</p></div><div><h3>Aim</h3><p>To evaluate the performance of NITs in predicting the 3-year FHD in CSPH-MASLD-cACLD, stratifying the study population according to the splenomegaly.</p></div><div><h3>Materials and Methods</h3><p>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.</p></div><div><h3>Results</h3><p>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), <em>p</em>&lt;0.0001] in “Splenomegaly -”, and ALBI [aSHR:1.273 (95% C.I.:1.199-1.305, <em>p</em>: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, <em>p</em>:0.04 and baseline AUC:0.625, <em>p</em>:0.03 respectively) (<strong>Figure</strong>).</p></div><div><h3>Conclusions</h3><p>The spleen area dramatically affects the predictive performance of the PINs in CSPH-MASLD-cACLD patients.</p></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":null,"pages":null},"PeriodicalIF":4.0000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Spleen area affects the predictive performance for decompensation of the platelet count-based non-invasive tools in MASLD-related cirrhosis: a preliminary observation\",\"authors\":\"\",\"doi\":\"10.1016/j.dld.2024.08.019\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><p>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.</p></div><div><h3>Aim</h3><p>To evaluate the performance of NITs in predicting the 3-year FHD in CSPH-MASLD-cACLD, stratifying the study population according to the splenomegaly.</p></div><div><h3>Materials and Methods</h3><p>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.</p></div><div><h3>Results</h3><p>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), <em>p</em>&lt;0.0001] in “Splenomegaly -”, and ALBI [aSHR:1.273 (95% C.I.:1.199-1.305, <em>p</em>: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, <em>p</em>:0.04 and baseline AUC:0.625, <em>p</em>:0.03 respectively) (<strong>Figure</strong>).</p></div><div><h3>Conclusions</h3><p>The spleen area dramatically affects the predictive performance of the PINs in CSPH-MASLD-cACLD patients.</p></div>\",\"PeriodicalId\":11268,\"journal\":{\"name\":\"Digestive and Liver Disease\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":4.0000,\"publicationDate\":\"2024-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Digestive and Liver Disease\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1590865824009381\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Digestive and Liver Disease","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1590865824009381","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
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。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
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.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
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.
期刊最新文献
Recent trends in foreign body ingestion (FBI) epidemiology: A national cohort study. Duodenal gastric heterotopia diagnosed by spectral CT. Feasibility, safety and efficacy of endoscopic submucosal dissection for recurrent superficial rectal neoplastic lesions after transanal microsurgery. Liver transplant for hepatocellular carcinoma in metabolic dysfunction-associated steatotic liver disease versus other etiologies: A meta-analysis. Sarcopenia in patients receiving TIPS is independently associated with increased risk of complications and mortality.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1