Wang Xixuan, Han Hao, Yang Jian, Cheng Yang, Yin Xiaochun, Gu Lihong, Xiao Jiangqiang, Wang Yi, Zou Xiaoping, Wang Lei, Zhang Ming, Zhuge Yuzheng, Zhang Feng
Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School.
School of Medicine, Southeast University Medical School, Nanjing Drum Tower Hospital.
Eur J Gastroenterol Hepatol. 2023 Apr 1;35(4):488-496. doi: 10.1097/MEG.0000000000002518. Epub 2023 Jan 31.
The liver stiffness- spleen diameter to platelet ratio score (LSPS model) can identify a high risk of decompensated events in cirrhotic patients. We aimed to evaluate the value of the LSPS model as a risk stratification strategy in the secondary prevention for cirrhotic patients with esophageal and gastric variceal bleeding (EGVB).
Consecutive EGVB patients who underwent liver stiffness measurement by acoustic radiation force impulse, platelet count and ultrasonography were enrolled between January 2013 and December 2019. We calculated the LSPS of all patients and followed up for over 2 years. The primary outcome was rebleeding. Transplant-free survival and overt hepatic encephalopathy (OHE) were the secondary outcomes.
A total of 131 patients were analyzed. The median value of the LSPS model is 0.1879. We developed risk stratification based on the LSPS model and divided the patients into two groups: the high-LSPS (LSPS > 0.1879) group and the low-LSPS (LSPS ≤ 0.1879) group. Sixty-two (47.33%) patients suffered rebleeding, in which there were 21 (31.92%) patients with low LSPS and 41 (63.08%) patients with high LSPS (hazard ratio 2.883; 95% confidence interval, 1.723-4.822, P < 0.001). For the whole cohort, the rates of transplant-free survival and OHE were consistently similar between the two groups at 2 years.
The LSPS is a reliable, noninvasive method for the detection of a high risk of rebleeding for the secondary prevention of EGVB.
肝硬度-脾直径与血小板比值评分（LSPS模型）可识别肝硬化患者失代偿事件的高风险。我们旨在评估LSPS模型作为食管胃静脉曲张破裂出血（EGVB）肝硬化患者二级预防中风险分层策略的价值。
纳入2013年1月至2019年12月期间连续接受声辐射力脉冲肝硬度测量、血小板计数和超声检查的EGVB患者。我们计算了所有患者的LSPS，并随访超过2年。主要结局是再出血。无移植生存率和显性肝性脑病（OHE）为次要结局。
共分析了131例患者。LSPS模型的中位数为0.1879。我们基于LSPS模型进行风险分层，将患者分为两组：高LSPS（LSPS＞0.1879）组和低LSPS（LSPS≤0.1879）组。62例（47.33%）患者发生再出血，其中低LSPS组21例（31.92%），高LSPS组41例（63.08%）（风险比2.883；95%置信区间，1.723 - 4.822，P＜0.001）。对于整个队列，两组在2年时的无移植生存率和OHE发生率始终相似。
LSPS是一种可靠的、非侵入性的方法，用于检测EGVB二级预防中再出血的高风险。
