Shearer Jessica E, Jones Rebecca, Parker Richard, Ferguson James, Rowe Ian A
Leeds Institute for Medical Research, University of Leeds, Leeds, United Kingdom; Leeds Liver Unit, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
Leeds Liver Unit, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
Clin Gastroenterol Hepatol. 2023 Mar;21(3):694-703.e8. doi: 10.1016/j.cgh.2022.03.015. Epub 2022 Mar 23.
BACKGROUND & AIMS: The clinical course of cirrhosis does not follow a predictable trajectory. Transient elastography (TE) is commonly used in clinical practice to diagnose liver fibrosis and increasingly to risk stratify patients. The aim of this study was to assess the natural history of advanced chronic liver disease (ACLD) defined by TE using electronic health record (EHR) data in a multistate framework.
TE data were collected between 2008 and 2019. Patients with a liver stiffness measurement (LSM) >10 kPa were included. Disease and procedure code information held in EHR was analyzed. Clinical events including decompensation, hepatocellular carcinoma (HCC), and death were identified. Outcomes were described in a multistate model using flexible parametric survival methods including LSM and the albumin bilirubin (ALBI) score.
Three thousand and twenty eight patients were included. Median follow up was 3.1 years. LSM and ALBI were associated with the development of varices and decompensation, and ALBI, age, sex, and viral liver disease were associated with the development of HCC from the compensated state. The cumulative incidence of HCC before decompensation was low for patients with alcohol-related liver disease (3.8%) and nonalcoholic fatty liver disease (1.3%) at 5 years after TE. Importantly, death was predicted to occur before decompensation or HCC in most cases.
Liver stiffness, ALBI score, and disease etiology are each associated with outcomes in a large contemporary cohort with ACLD. EHR data can be used to define clinical progression in these patients, facilitating large clinical effectiveness trials and cost-effectiveness analyses.
肝硬化的临床病程并无可预测的轨迹。瞬时弹性成像（TE）在临床实践中常用于诊断肝纤维化，并且越来越多地用于对患者进行风险分层。本研究的目的是在多状态框架下，使用电子健康记录（EHR）数据评估由TE定义的晚期慢性肝病（ACLD）的自然病史。
收集2008年至2019年期间的TE数据。纳入肝脏硬度测量值（LSM）>10 kPa的患者。分析EHR中保存的疾病和手术代码信息。识别包括失代偿、肝细胞癌（HCC）和死亡在内的临床事件。使用包括LSM和白蛋白胆红素（ALBI）评分在内的灵活参数生存方法，在多状态模型中描述结局。
共纳入3028例患者。中位随访时间为3.1年。LSM和ALBI与静脉曲张和失代偿的发生相关，而ALBI、年龄、性别和病毒性肝病与代偿期患者发生HCC相关。对于酒精性肝病患者，失代偿前HCC的5年累积发病率较低（3.8%），非酒精性脂肪性肝病患者为1.3%。重要的是，在大多数情况下，预计死亡会在失代偿或HCC之前发生。
在当代一个大型ACLD队列中，肝脏硬度、ALBI评分和疾病病因均与结局相关。EHR数据可用于定义这些患者的临床进展，有助于进行大型临床疗效试验和成本效益分析。
