CHESS Center, Center of Portal Hypertension, Department of Radiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.
Department of Infectious Disease, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Am J Gastroenterol. 2022 Oct 1;117(10):1605-1613. doi: 10.14309/ajg.0000000000001873. Epub 2022 Jun 15.
In patients with compensated advanced chronic liver disease (cACLD), the invasive measurement of hepatic venous pressure gradient is the best predictor of hepatic decompensation. This study aimed at developing an alternative risk prediction model to provide a decompensation risk assessment in cACLD.
Patients with cACLD were retrospectively included from 9 international centers within the Portal Hypertension Alliance in China (CHESS) network. Baseline variables from a Japanese cohort of 197 patients with cACLD were examined and fitted a Cox hazard regression model to develop a specific score for predicting hepatic decompensation. The novel score was validated in an external cohort (n = 770) from 5 centers in China, Singapore, Korea, and Egypt, and was further assessed for the ability of predicting clinically significant portal hypertension in a hepatic venous pressure gradient cohort (n = 285).
In the derivation cohort, independent predictors of hepatic decompensation were identified including Stiffness of liver, Albumin, Varices, and platElets and fitted to develop the novel score, termed "SAVE" score. This score performed significantly better (all P < 0.05) than other assessed methods with a time-dependent receiver operating characteristic curve of 0.89 (95% confidence interval [CI]: 0.83-0.94) and 0.83 (95% CI: 0.73-0.92) in the derivation and validation cohorts, respectively. The decompensation risk was best stratified by the cutoff values at -6 and -4.5. The 5-year cumulative incidences of decompensation were 0%, 24.9%, and 69.0% in the low-risk, middle-risk, and high-risk groups, respectively ( P < 0.001). The SAVE score also accurately predicted clinically significant portal hypertension (AUC, 0.85 95% CI: 0.80-0.90).
The SAVE score can be readily incorporated into clinical practice to accurately predict the individual risk of hepatic decompensation in cACLD.
在代偿期晚期慢性肝病（cACLD）患者中，肝静脉压力梯度的侵入性测量是肝失代偿的最佳预测指标。本研究旨在开发一种替代风险预测模型，为 cACLD 提供失代偿风险评估。
从中国门静脉高压联盟（CHESS）网络的 9 个国际中心回顾性纳入 cACLD 患者。检查了来自日本队列的 197 例 cACLD 患者的基线变量，并使用 Cox 风险回归模型拟合了特定的评分，以预测肝失代偿。该新评分在中国（n = 770）、新加坡、韩国和埃及的 5 个中心的外部队列中进行了验证，并进一步在肝静脉压力梯度队列（n = 285）中评估了预测临床显著门静脉高压的能力。
在推导队列中，确定了肝失代偿的独立预测因素，包括肝脏硬度、白蛋白、静脉曲张和血小板，并拟合开发了新的评分，称为“SAVE”评分。与其他评估方法相比，该评分的表现明显更好（所有 P < 0.05），其时间依赖性接受者操作特征曲线在推导和验证队列中分别为 0.89（95%置信区间 [CI]：0.83-0.94）和 0.83（95% CI：0.73-0.92）。截断值为-6 和-4.5 时，失代偿风险分层最佳。低危、中危和高危组的 5 年累积失代偿发生率分别为 0%、24.9%和 69.0%（P < 0.001）。SAVE 评分也能准确预测临床显著门静脉高压（AUC，0.85；95%CI：0.80-0.90）。
SAVE 评分可以很容易地纳入临床实践，以准确预测 cACLD 患者肝失代偿的个体风险。
