Shin Seunghwan, Kim Seung Up, Park Jun Yong, Kim Do Young, Ahn Sang Hoon, Kim Beom Kyung
Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea.
Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 03722, Korea.
Diagnostics (Basel). 2022 Feb 9;12(2):441. doi: 10.3390/diagnostics12020441.
Esophageal varices (EVs) can be accurately predicted using PH and varices risk scores. We aimed to validate their prognostic performances. Methods: We enrolled patients with B-viral cirrhosis as the training cohort ( = 503). Areas under receiver operating characteristic curves (AUROCs) for HEV were calculated for PH (=-5.953 + 0.188 × liver stiffness (LS) + 1.583 × sex (1:male/0:female) + 26.705 × spleen diameter/platelet count ratio) and varices (=-4.364 + 0.538 × spleen diameter -0.049 × platelet count -0.044 × LS + 0.001 × LS × platelet count) risk scores, and compared to LSPS (=LS × spleen diameter/platelet count). An independent cohort was recruited for further validation ( = 222). In the training cohort, the varices risk score showed the highest AUROC (0.926), followed by the PH risk score (0.924) and LSPS (0.924), but without any statistically significant differences. For varices risk scores ≤-1.70 and ≥1.48, a 95.0% negative predictive value (NPV) and 91.2% positive predictive value (PPV) were observed, respectively. At PH risk scores ≤2.25 and ≥7.71, 95.0% NPV and 90.0% PPV were observed, respectively. At LSPS ≤1.73 and ≥13.9, 95.3% NPV and 95.0% PPV were observed, respectively. The EV bleeding (EVB) risk during follow-up increased stepwise and significantly when stratified by PH, varices risk scores, and LSPS (all < 0.001). In the validation cohort, NPVs were generally similar when stratified by PH (88.2%), varices risk scores (93.2%), and LSPS (88.9%); however, corresponding PPVs were suboptimal. PH and variceal risk scores are reliable for predicting HEV and future EVB. Patients with PH and varices risk scores ≤2.25 and ≤-1.70, respectively, may avoid endoscopy safely. For convenience, LSPS might be a good alternative, with comparable prognostic performance to these two models.
使用门静脉高压（PH）和静脉曲张风险评分可以准确预测食管静脉曲张（EVs）。我们旨在验证它们的预后性能。方法：我们纳入了B型病毒性肝硬化患者作为训练队列（n = 503）。计算PH（=-5.953 + 0.188×肝脏硬度（LS）+ 1.583×性别（1：男性/0：女性）+ 26.705×脾直径/血小板计数比值）和静脉曲张（=-4.364 + 0.538×脾直径 -0.049×血小板计数 -0.044×LS + 0.001×LS×血小板计数）风险评分的受试者操作特征曲线下面积（AUROCs），并与LSPS（=LS×脾直径/血小板计数）进行比较。招募了一个独立队列进行进一步验证（n = 222）。在训练队列中,静脉曲张风险评分显示出最高的AUROC（0.926），其次是PH风险评分（0.924）和LSPS（0.924），但没有任何统计学上的显著差异。对于静脉曲张风险评分≤-1.70和≥1.48，分别观察到95.0%的阴性预测值（NPV）和91.2%的阳性预测值（PPV）。在PH风险评分≤2.25和≥7.71时，分别观察到95.0%的NPV和90.0%的PPV。在LSPS≤1.73和≥13.9时，分别观察到95.3%的NPV和95.0%的PPV。当根据PH、静脉曲张风险评分和LSPS进行分层时，随访期间的EV出血（EVB）风险呈逐步显著增加（均P < 0.001）。在验证队列中，根据PH（88.2%）、静脉曲张风险评分（93.2%）和LSPS（88.9%）分层时，NPV总体相似；然而，相应的PPV并不理想。PH和静脉曲张风险评分在预测HEV和未来EVB方面是可靠的。PH和静脉曲张风险评分分别≤2.25和≤-1.70的患者可以安全地避免内镜检查。为方便起见，LSPS可能是一个很好的替代方法，其预后性能与这两个模型相当。
