Thiele Maja, Johansen Stine, Israelsen Mads, Trebicka Jonel, Abraldes Juan G, Gines Pere, Krag Aleksander
Department of Gastroenterology and Hepatology, Fibrosis, Fatty Liver and Steatohepatitis Research Center Odense (FLASH), Odense University Hospital, Odense, Denmark.
Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
Hepatology. 2025 Mar 1;81(3):1019-1037. doi: 10.1097/HEP.0000000000000618. Epub 2023 Oct 6.
Noninvasive tests (NITs) are used in all aspects of liver disease management. Their most prominent break-through since the millennium has been in advancing early detection of liver fibrosis, but their use is not limited to this. In contrast to the symptom-driven assessment of decompensation in patients with cirrhosis, NITs provide not only opportunities for earlier diagnoses but also accurate prognostication, targeted treatment decisions, and a means of monitoring disease. NITs can inform disease management and decision-making based on validated cutoffs and standardized interpretations as a valuable supplement to clinical acumen. The Baveno VI and VII consensus meetings resulted in tangible improvements to pathways of care for patients with compensated and decompensated advanced chronic liver disease, including the combination of platelet count and transient elastography to diagnose clinically significant portal hypertension. Furthermore, circulating NITs will play increasingly important roles in assessing the response to interventions against ascites, variceal bleeding, HE, acute kidney injury, and infections. However, due to NITs' wide availability, there is a risk of inaccurate use, leading to a waste of resources and flawed decisions. In this review, we describe the uses and pitfalls of NITs for hepatic decompensation, from risk stratification in primary care to treatment decisions in outpatient clinics, as well as for the in-hospital management of patients with acute-on-chronic liver failure. We summarize which NITs to use when, for what indications, and how to maximize the potential of NITs for improved patient management.
非侵入性检测（NITs）被用于肝病管理的各个方面。自千禧年以来，它们最显著的突破在于推动了肝纤维化的早期检测，但其用途并不局限于此。与基于症状对肝硬化患者失代偿情况进行评估不同，NITs不仅提供了更早诊断的机会，还能进行准确的预后判断、做出有针对性的治疗决策以及提供疾病监测手段。NITs可根据经过验证的临界值和标准化解读为疾病管理和决策提供信息，作为临床敏锐度的宝贵补充。巴韦诺VI和VII共识会议切实改善了代偿期和失代偿期晚期慢性肝病患者的护理路径，包括将血小板计数与瞬时弹性成像相结合以诊断具有临床意义的门静脉高压。此外，循环NITs在评估针对腹水、静脉曲张出血、肝性脑病、急性肾损伤和感染的干预措施的反应方面将发挥越来越重要的作用。然而，由于NITs广泛可得，存在使用不当的风险，可能导致资源浪费和决策失误。在本综述中，我们描述了NITs在肝失代偿中的用途和陷阱，从初级保健中的风险分层到门诊诊所的治疗决策，以及对慢性肝衰竭急性发作患者的院内管理。我们总结了何时使用、用于何种适应症以及如何最大化NITs在改善患者管理方面的潜力。
