计算机断层扫描结果作为酒精相关性肝炎结局的新型预测因子。
Computed Tomography Findings as a Novel Predictor of Alcohol-Associated Hepatitis Outcomes.
机构信息
Gastrointestinal Unit, Massachusetts General Hospital, 55 Fruit St, Blake 4, Boston, MA, USA.
Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
出版信息
Dig Dis Sci. 2020 Jan;65(1):312-321. doi: 10.1007/s10620-019-05721-4. Epub 2019 Jul 30.
BACKGROUND
Accurate prediction of outcomes for alcohol-associated hepatitis (AH) is critical, as prognosis determines treatment eligibility. Computed tomography (CT) features may provide prognostic information beyond traditional models.
AIMS
Our aim was to identify CT features that predict outcomes in AH.
METHODS
We studied 108 patients retrospectively with definite or probable AH, who underwent admission abdominal CT. A radiologist blinded to outcome evaluated eight CT features. The primary outcome was 90-day mortality.
RESULTS
Twenty-five (23.2%) patients died within 90 days. While traditional prognostic tools, including Maddrey discriminant function (DF), predicted 90-day mortality (OR 1.01 [1.00, 1.03], P = 0.02), abdominal CT findings were also accurate predictors. On abdominal CT, patients with severe AH had larger volume of ascites (moderate/large volume: 34.0 vs. 8.2%, P < 0.0001), longer liver length (17.1 vs. 15.1 cm, P = 0.001), greater liver heterogeneity (moderate/severe: 21.3 vs. 8.2%, P = 0.007), and more likely to have splenomegaly (42.6 vs. 18.0%, P = 0.009) than those with mild AH. Univariate analysis revealed that ascites volume (OR 2.59 [1.35, 4.96], P = 0.004) predicted 90-day mortality. In multivariate analysis, degree of ascites predicted 90-day mortality when controlling for Maddrey DF (OR 2.36 [1.19, 4.69], P = 0.01) and trended toward significance when controlling for MELD score (OR 2.02 [0.95, 4.30], P = 0.07).
CONCLUSION
CT findings in AH differentiate disease severity and predict 90-day mortality; therefore, the role of CT warrants further investigation as a tool in AH management.
背景
准确预测酒精性肝炎（AH）的预后至关重要，因为预后决定了治疗的资格。计算机断层扫描（CT）特征可能提供超越传统模型的预后信息。
目的
我们旨在确定 CT 特征可预测 AH 的预后。
方法
我们回顾性研究了 108 例明确或可能的 AH 患者，他们接受了入院腹部 CT 检查。一位对结果不知情的放射科医生评估了 8 个 CT 特征。主要结局是 90 天死亡率。
结果
25 例（23.2%）患者在 90 天内死亡。尽管包括 Maddrey 判别函数（DF）在内的传统预后工具预测 90 天死亡率（OR 1.01[1.00，1.03]，P=0.02），但腹部 CT 结果也是准确的预测指标。在腹部 CT 上，严重 AH 患者的腹水体积更大（大量/中量体积：34.0%比 8.2%，P<0.0001），肝长度更长（17.1 比 15.1cm，P=0.001），肝不均匀性更严重（中重度：21.3%比 8.2%，P=0.007），更有可能发生脾肿大（42.6%比 18.0%，P=0.009）。单变量分析显示腹水体积（OR 2.59[1.35，4.96]，P=0.004）可预测 90 天死亡率。多变量分析显示，在控制 Maddrey DF 时，腹水程度可预测 90 天死亡率（OR 2.36[1.19，4.69]，P=0.01），在控制 MELD 评分时则具有显著趋势（OR 2.02[0.95，4.30]，P=0.07）。
结论
AH 的 CT 表现可区分疾病严重程度并预测 90 天死亡率；因此，CT 的作用作为 AH 管理的一种工具值得进一步研究。
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