M. Dallio, M. Romeo, F. Di Nardo, P. Vaia, C. Napolitano, C. Basile, S. Olivieri, L. Vitale, M. Niosi, A. Federico
{"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":"M. Dallio, M. Romeo, F. Di Nardo, P. Vaia, C. Napolitano, C. Basile, S. Olivieri, L. Vitale, M. Niosi, A. Federico","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><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":"56 ","pages":"Page S323"},"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\":\"M. Dallio, M. Romeo, F. Di Nardo, P. Vaia, C. Napolitano, C. Basile, S. Olivieri, L. Vitale, M. Niosi, A. Federico\",\"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><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\":\"56 \",\"pages\":\"Page S323\"},\"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}
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.
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
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Symposia and Mini-symposia.