Capital Medical University Affiliated Beijing Ditan Hospital, Department of Gastroenterology, Beijing, China.
Capital Medical University Affiliated Beijing Ditan Hospital, Department of Medical Ultrasound, Beijing, China.
Ann Hepatol. 2020 May-Jun;19(3):287-294. doi: 10.1016/j.aohep.2019.12.007. Epub 2020 Feb 11.
The predictors for gastroesophageal varices (GOV) and hemorrhage development have not been well studied in different liver diseases or different population. This study aimed to evaluate whether a new algorithm focusing on chronic hepatitis B (CHB) patients is also applicable to other chronic liver diseases (CLDs) in Chinese population.
We retrospectively analyzed 659 CHB patients and 386 patients with other CLDs. A total of 439 CHB patients were included in training set, the other 220 CHB patients and other patients with CLDs were included in validation set. A new algorithm for diagnosing GOV was established and its sensitivity and specificity for predicting the varices was verified.
Multivariable logistic regression revealed that the rough surface of the liver (p<0.001), splenic thickness (p<0.001), and liver stiffness (p=0.006) were independent predictors of GOV. The new algorithm was considered to be a reliable diagnostic model to evaluate the presence of varices. The AUROC was 0.94 (p<0.001) in CHB validation set and 0.90 (<0.001) in non-CHB validation set. When the cut-off value was chosen as -1.048, the sensitivity and specificity in diagnosing GOV in CHB population were 89.1% and 82.5%, respectively. Importantly, the new algorithm accurately predicted the variceal hemorrhage not only in CHB patients, but also in patients with other CLDs.
The new algorithm is regarded as a reliable model to prognosticate varices and variceal hemorrhage, and stratified not only the high-risk CHB patients, but also in patients with other CLDs for developing GOV and variceal bleeding.
胃食管静脉曲张（GOV）和出血发展的预测因子在不同的肝脏疾病或不同人群中尚未得到很好的研究。本研究旨在评估一种针对慢性乙型肝炎（CHB）患者的新算法是否也适用于中国人群中的其他慢性肝病（CLD）。
我们回顾性分析了 659 例 CHB 患者和 386 例其他 CLD 患者。共有 439 例 CHB 患者纳入训练集，其余 220 例 CHB 患者和其他 CLD 患者纳入验证集。建立了一种新的 GOV 诊断算法，并验证了其预测静脉曲张的敏感性和特异性。
多变量逻辑回归显示，肝脏表面粗糙（p<0.001）、脾厚（p<0.001）和肝硬度（p=0.006）是 GOV 的独立预测因子。新算法被认为是评估静脉曲张存在的可靠诊断模型。在 CHB 验证集中，AUROC 为 0.94（p<0.001），在非-CHB 验证集中为 0.90（<0.001）。当选择截断值为-1.048 时，CHB 人群中 GOV 的诊断敏感性和特异性分别为 89.1%和 82.5%。重要的是，新算法不仅能准确预测 CHB 患者的静脉曲张出血，也能预测其他 CLD 患者的静脉曲张出血。
新算法被认为是一种可靠的预测静脉曲张和静脉曲张出血的模型，不仅可以对高危 CHB 患者进行分层，还可以对其他 CLD 患者进行分层，以预测 GOV 和静脉曲张出血的发生。
