Oral Hakan, Ozturk Bengi, Kav Taylan, Keskin Onur
Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey.
Division of Gastroenterology, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey.
Intern Emerg Med. 2024 Oct 10. doi: 10.1007/s11739-024-03788-0.
This study aims to investigate the effectiveness of non-invasive fibrosis markers in predicting varices in compensated advanced chronic liver disease patients and variceal bleeding in decompensated cirrhotic patients. Between 1 July 2020-2021, 137 newly diagnosed cirrhosis patients (67 females/70 males; mean age: 53.35) were included in the study. The diagnosis of cirrhosis was made based on clinical, laboratory, imaging, and, if available, biopsy findings. Laboratory and clinical parameters, including lysyl oxidase-like protein 2 (LOXL2), were recorded for all patients. Commonly used noninvasive fibrosis scores were calculated, and endoscopies were performed to assess varices. All patients were followed up for 12 months, and variceal bleeding events were recorded. Parameters that could predict the presence of varices and variceal bleeding were identified using appropriate statistical methods. Out of the 137 cirrhotic patients, 55 were in the compensated stage and 82 were in the decompensated stage. Varices were detected in 36 (65%) of the compensated cirrhotic patients. It was found that a variceal score derived from spleen size and the ELF score could be used to predict varices (AUC: 0.83). Variceal bleeding developed in 26 (31%) of the patients with decompensated cirrhosis. It was determined that a scoring system derived from albumin, spleen size, LOXL2 level, and the Lok index could be used to predict variceal bleeding in this patient group (AUC: 0.845). This study demonstrates that, besides device-dependent examinations, non-invasive fibrosis scores and various serum parameters can predict varices and variceal bleeding in cirrhotic patients.
本研究旨在探讨非侵入性纤维化标志物在预测代偿期晚期慢性肝病患者静脉曲张及失代偿期肝硬化患者静脉曲张出血方面的有效性。2020年7月1日至2021年期间，137例新诊断的肝硬化患者（67例女性/70例男性；平均年龄：53.35岁）纳入本研究。肝硬化的诊断基于临床、实验室、影像学检查结果，如有条件，还包括活检结果。记录所有患者的实验室和临床参数，包括赖氨酰氧化酶样蛋白2（LOXL2）。计算常用的非侵入性纤维化评分，并进行内镜检查以评估静脉曲张情况。所有患者随访12个月，记录静脉曲张出血事件。采用适当的统计方法确定可预测静脉曲张和静脉曲张出血的参数。在137例肝硬化患者中，55例处于代偿期，82例处于失代偿期。在36例（65%）代偿期肝硬化患者中检测到静脉曲张。发现由脾脏大小和ELF评分得出的静脉曲张评分可用于预测静脉曲张（曲线下面积：0.83）。26例（31%）失代偿期肝硬化患者发生了静脉曲张出血。确定由白蛋白、脾脏大小、LOXL2水平和Lok指数得出的评分系统可用于预测该患者组的静脉曲张出血（曲线下面积：0.845）。本研究表明，除了依赖设备的检查外，非侵入性纤维化评分和各种血清参数可预测肝硬化患者的静脉曲张和静脉曲张出血。
