二维剪切波弹性成像联合 MELD 提高了慢加急性乙型肝炎肝衰竭患者的预后准确性。
2D shear wave elastography combined with MELD improved prognostic accuracy in patients with acute-on-chronic hepatitis B liver failure.
机构信息
Department of Medical Ultrasonics, the Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, China.
GuangDong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, China.
出版信息
Eur Radiol. 2018 Oct;28(10):4465-4474. doi: 10.1007/s00330-018-5336-z. Epub 2018 Apr 25.
OBJECTIVES
To evaluate accuracy of two-dimensional shear wave elastography (2D SWE) and develop and validate a new prognostic score in predicting prognosis of acute-on-chronic liver failure (ACLF) patients.
METHODS
From 1 October 2013 to 30 September 2015, we consecutively enrolled 290 patients, sequentially collected data (including 2D SWE, ultrasound parameters, laboratory data and prognostic scores) and recorded patients' outcome (recovering/steady or worsening) during a 90-day follow-up period. We evaluated ability of 2D SWE to predict outcomes of acute-on-chronic hepatitis B liver failure (ACLF-HBV) patients. We developed a new score (MELD-SWE, combining MELD and SWE values) for predicting mortality risk of ACLF-HBV in 179 patients in a derivation group, and validated in 111 patients.
RESULTS
2D SWE values were higher in worsening patients than recovering/steady ones (p < 0.001). Accuracy of 2D SWE in predicting outcomes of ACLF-HBV was comparable to that of the MELD score (p = 0.441). MELD-SWE showed a significantly higher prognostic value than MELD in both derivation (AUROC, 0.80 vs. 0.76, p = 0.040) and validation (AUROC, 0.87 vs. 0.82, p = 0.018) group.
CONCLUSIONS
The MELD-SWE score, combining MELD and SWE values, was superior to MELD alone for outcoming prediction in patients with ACLF-HBV.
KEY POINTS
• 2D SWE is a simple prognostic evaluation tool in patients with ACLF-HBV. • MELD-SWE was created in this study: 1.3×MELD + 0.3×2D SWE (kPa). • MELD-SWE score was superior to MELD alone for outcoming prediction in ACLF-HBV. • In this study, 46.8 was the optimal cut-off value of MELD-SWE score.
目的
评估二维剪切波弹性成像（2D SWE）的准确性，并开发和验证一种新的预后评分，以预测慢加急性肝衰竭（ACLF）患者的预后。
方法
2013 年 10 月 1 日至 2015 年 9 月 30 日，我们连续纳入 290 例患者，连续采集数据（包括 2D SWE、超声参数、实验室数据和预后评分），并在 90 天随访期间记录患者的结局（好转/稳定或恶化）。我们评估了 2D SWE 预测乙型肝炎相关慢加急性肝衰竭（ACLF-HBV）患者结局的能力。我们在 179 例患者中建立了一个新的评分（MELD-SWE，结合 MELD 和 SWE 值），并在 111 例患者中进行了验证。
结果
恶化患者的 2D SWE 值高于好转/稳定患者（p<0.001）。2D SWE 预测 ACLF-HBV 结局的准确性与 MELD 评分相当（p=0.441）。MELD-SWE 在推导组（AUROC，0.80 与 0.76，p=0.040）和验证组（AUROC，0.87 与 0.82，p=0.018）中均显示出比 MELD 更高的预后价值。
结论
MELD-SWE 评分，结合 MELD 和 SWE 值，优于单独的 MELD 用于预测 ACLF-HBV 患者的结局。
关键要点
2D SWE 是 ACLF-HBV 患者预后评估的简单工具。
在本研究中创建了 MELD-SWE：1.3×MELD+0.3×2D SWE（kPa）。
MELD-SWE 评分优于单独的 MELD 用于预测 ACLF-HBV 的结局。
在本研究中，MELD-SWE 评分的最佳截断值为 46.8。
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