Vutien Philip, Barnard Giustini Abbey, Kim Nicole J, Moon Andrew M, Hsu Chun-Nan, Mezzacappa Catherine, Borgerding Joleen A, Johnson Kay M, VoPham Trang, Berry Kristin, Beste Lauren A, Kaplan David E, Taddei Tamar H, Ioannou George N
Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, Washington, USA.
Division of Gastroenterology, Department of Medicine, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA.
Hepatology. 2024 Dec 17. doi: 10.1097/HEP.0000000000001183.
Recently proposed "Rule-of-Five" criteria define compensated advanced chronic liver disease (cACLD) and clinically significant portal hypertension (CSPH) using liver stiffness (LS) and platelet count. We aimed to validate these criteria by determining whether they are associated with risk of adverse outcomes.
Patients without prior hepatic decompensation or HCC who underwent LS and platelet measurements (n = 17,076) were categorized as follows: no cACLD (LS: 2.5-9.9 kPa); probable cACLD (LS: 10-14.9 kPa); certain cACLD-no CSPH (LS: 15-19.9 kPa and platelets ≥110,000/µL or LS 20-24.9 kPa and platelets ≥150,000/µL); probable CSPH (LS 15-19.9 kPa and platelets <110,000/µL or LS 20-24.9 and platelets <150,000/µL); and certain CSPH (LS ≥25 kPa), which we further subdivided into 25-49.9 and 50-75 kPa.During a median follow-up of 2.82 years, each increase in the "Rule-of-Five" category was associated linearly with higher risks of death (HR: 1.22, 95% CI: 1.18-1.25) and decompensation (HR: 1.52, 95% CI: 1.46-1.58). Compared to patients with LS 25-49.9 kPa, those with LS 50-75 kPa ("critical" CSPH) had approximately double the risk of decompensation (11.24 vs. 4.20 per 100 patient-years) and death (9.85 vs. 6.98 per 100 patient-years).
The Baveno VII "Rule-of-Five" criteria provide a valid system for stratifying risks of death and hepatic decompensation and should be used routinely in patients with chronic liver disease. Among patients with CSPH (LS ≥25 kPa), the subgroup with LS 50-75 kPa ("critical" CSPH) has approximately double the risk of death and hepatic decompensation than LS 25-49.9 kPa.
最近提出的“五法则”标准利用肝脏硬度（LS）和血小板计数来定义代偿期晚期慢性肝病（cACLD）和临床显著性门静脉高压（CSPH）。我们旨在通过确定这些标准是否与不良结局风险相关来验证它们。
对未发生过肝失代偿或肝癌且接受了LS和血小板测量的患者（n = 17,076）进行如下分类：无cACLD（LS：2.5 - 9.9kPa）；可能为cACLD（LS：10 - 14.9kPa）；确定为cACLD但无CSPH（LS：15 - 19.9kPa且血小板≥110,000/µL或LS 20 - 24.9kPa且血小板≥150,000/µL）；可能为CSPH（LS 15 - 19.9kPa且血小板<110,000/µL或LS 20 - 24.9且血小板<150,000/µL）；以及确定为CSPH（LS≥25kPa），我们将其进一步细分为25 - 49.9kPa和50 - 75kPa。在中位随访2.82年期间，“五法则”分类每增加一级，死亡风险（HR：1.22，95%CI：1.18 - 1.25）和失代偿风险（HR：1.52，95%CI：1.46 - 1.58）均呈线性增加。与LS为25 - 49.9kPa的患者相比，LS为50 - 75kPa（“临界”CSPH）的患者失代偿风险（每100患者年分别为11.24对4.20）和死亡风险（每100患者年分别为9.85对6.98）约增加一倍。
巴韦诺VII“五法则”标准为分层死亡风险和肝失代偿风险提供了一个有效的系统，应常规用于慢性肝病患者。在CSPH（LS≥25kPa）患者中，LS为50 - 75kPa（“临界”CSPH）的亚组死亡和肝失代偿风险比LS为25 - 49.9kPa的患者约高一倍。
