Lin Huapeng, Lai Jimmy Che-To, Wong Grace Lai-Hung, Delamarre Adèle, Ahn Sang Hoon, Li Guanlin, Kim Beom Kyung, Liang Lilian Yan, Lee Hye Won, Song Sherlot Juan, Chan Henry Lik-Yuen, Wong Vincent Wai-Sun, de Lédinghen Victor, Kim Seung Up, Yip Terry Cheuk-Fung
Medical Data Analytics Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
Aliment Pharmacol Ther. 2023 Nov;58(9):920-928. doi: 10.1111/apt.17699. Epub 2023 Aug 30.
Baveno VII was proposed for non-invasive identification of clinically significant portal hypertension. However, a substantial proportion of patients is classified in the grey zone (i.e., liver stiffness 15-24.9 kPa and/or platelet count <150 × 10 /L).
To evaluate the risk and predictors of hepatic decompensation in patients in the grey zone, and to determine the prognostic role of spleen stiffness measurement.
We included prospective cohorts (from Hong Kong, Korea and France) of patients who had undergone transient elastography examination for chronic liver disease. We estimated risk of hepatic decompensation using competing risk regression with hepatocellular carcinoma and non-liver-related death as competing events.
We identified 2763 patients with compensated advanced chronic liver disease (cACLD). There were 1243 (44.9%) and 536 (19.4%) patients in the Baveno VII grey zone and high-risk groups, respectively. The cumulative incidence of decompensation at 5 years was significantly different among low-risk (0.6% [95% CI: 0.2%-1.3%]), grey zone 4.2% (95% CI: 3.1%-5.4%) and high-risk groups (11.4% [95% CI: 8.7%-14.6%]). By competing risk analysis, aetiology of liver disease (alcohol-related liver disease), albumin-bilirubin score and alkaline phosphatase level were independently associated with decompensation among patients in the grey zone. The combination of Baveno VII and spleen stiffness significantly reduced patients classified into grey zone (12.8% in cACLD patients), while maintaining high discrimination of decompensation in low- and high-risk groups.
Patients in grey zone of Baveno VII criteria remain at high risk of hepatic decompensation. Clinical risk factors and spleen stiffness can further stratify the risk in such patients.
巴韦诺VII标准旨在用于无创识别具有临床意义的门静脉高压。然而，相当一部分患者被归类于灰色地带（即肝脏硬度为15 - 24.9kPa和/或血小板计数<150×10⁹/L）。
评估灰色地带患者肝失代偿的风险及预测因素，并确定脾脏硬度测量的预后作用。
我们纳入了（来自中国香港、韩国和法国）因慢性肝病接受瞬时弹性成像检查的患者前瞻性队列。我们使用以肝细胞癌和非肝脏相关死亡作为竞争事件的竞争风险回归来估计肝失代偿风险。
我们识别出2763例代偿期晚期慢性肝病（cACLD）患者。分别有1243例（44.9%）和536例（19.4%）患者处于巴韦诺VII灰色地带和高危组。低风险组（0.6% [95%CI：0.2% - 1.3%]）、灰色地带组（4.2% [95%CI：3.1% - 5.4%]）和高危组（11.4% [95%CI：8.7% - 14.6%]）5年时失代偿的累积发生率有显著差异。通过竞争风险分析，肝病病因（酒精性肝病）、白蛋白 - 胆红素评分和碱性磷酸酶水平与灰色地带患者的失代偿独立相关。巴韦诺VII标准与脾脏硬度相结合可显著减少归类于灰色地带的患者（cACLD患者中占12.8%），同时在低风险和高风险组中保持对失代偿的高辨别力。
巴韦诺VII标准灰色地带的患者仍有较高的肝失代偿风险。临床风险因素和脾脏硬度可进一步对此类患者的风险进行分层。
