Ananchuensook Prooksa, Piyawannasuth Kingkomon, Suksawatamnuay Sirinporn, Thaimai Panarat, Siripon Nipaporn, Sriphoosanaphan Supachaya, Thanapirom Kessarin, Komolmit Piyawat
Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Center of Excellence in Liver Diseases, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
PLoS One. 2025 Jul 17;20(7):e0327967. doi: 10.1371/journal.pone.0327967. eCollection 2025.
Variceal bleeding is associated with poor prognosis in patients with hepatocellular carcinoma. Therefore, it is essential to identify indicators of high-risk varices (HRV) and provide prompt intervention.
To validate and modify albumin-bilirubin and platelet scores to predict high-risk varices in patients with hepatocellular carcinoma.
We enrolled patients with hepatocellular carcinoma and esophagogastroduodenoscopy reports at King Chulalongkorn Memorial Hospital, Bangkok, Thailand, between 2015 and 2022. The nearest demographic and clinical characteristics and laboratory values were reviewed retrospectively within 6 months before the esophagogastroduodenoscopy. Albumin-bilirubin and platelet counts were calculated from the albumin-bilirubin grade plus score from platelet count. We evaluated the new modified albumin-bilirubin and platelet (mALBI-PLT)'s in predicting HRV by dividing participants into a training cohort (first half) and a validation cohort (second half).
Of 564 patients with hepatocellular carcinoma, 277 were included. Most patients (232 [83.8%]) had Child-Turcotte-Pugh A cirrhosis, whereas 131 (47.3%), 85 (30.7%), and 60 (22.0%) had Barcelona Clinic Liver Cancer stages A, B, and C, respectively. Thirty-eight (15.6%) participants had HRV on esophagogastroduodenoscopy. On multivariate analysis, modified albumin-bilirubin grades 2b and 3 and platelet count ≤150,000/µL were significantly associated with HRV. With a cut-off value of 2, the mALBI-PLT showed comparable performance in both cohorts, yielding sensitivities of 93.8% and 95.5%, and negative predictive values (NPV) of 98.1% and 98.0%, respectively. In the entire cohort, the albumin-bilirubin and platelet scores, and mALBI-PLT score >2, demonstrated excellent sensitivities (97.4% and 94.7%), respectively, (with NPV of 98.7% and 98.0%), in predicting HRV.
Modified albumin-bilirubin grade and platelet at cut-off 150,000/µL exhibited significant association with high-risk varices in patients with hepatocellular carcinoma. Moreover, hepatocellular carcinoma patients with modified albumin-bilirubin grade 1 or 2a, together with platelets > 150,000/µL, may be able to avoid oesophagogastroduodenoscopy.
肝细胞癌患者发生静脉曲张出血与预后不良相关。因此，识别高危静脉曲张（HRV）指标并及时进行干预至关重要。
验证并修正白蛋白-胆红素和血小板评分，以预测肝细胞癌患者的高危静脉曲张。
我们纳入了2015年至2022年期间在泰国曼谷朱拉隆功国王纪念医院就诊的肝细胞癌患者及食管胃十二指肠镜检查报告。回顾性分析食管胃十二指肠镜检查前6个月内最近的人口统计学和临床特征以及实验室检查值。根据白蛋白-胆红素分级加上血小板计数得分计算白蛋白-胆红素和血小板计数。我们通过将参与者分为训练队列（前半部分）和验证队列（后半部分）来评估新修正的白蛋白-胆红素和血小板（mALBI-PLT）在预测HRV方面的作用。
在564例肝细胞癌患者中，277例被纳入研究。大多数患者（232例[83.8%]）为Child-Turcotte-Pugh A级肝硬化，而巴塞罗那临床肝癌分期A、B、C期的患者分别有131例（47.3%）、85例（30.7%）和60例（22.0%）。38例（15.6%）参与者在食管胃十二指肠镜检查中发现有HRV。多因素分析显示，修正的白蛋白-胆红素2b级和3级以及血小板计数≤150,000/µL与HRV显著相关。mALBI-PLT的临界值为2时，在两个队列中表现相当，敏感性分别为93.8%和95.5%，阴性预测值（NPV）分别为98.1%和98.0%。在整个队列中白蛋白-胆红素和血小板评分以及mALBI-PLT评分>2在预测HRV时分别显示出优异的敏感性（分别为97.4%和94.7%）（NPV分别为98.7%和98.0%）。
修正的白蛋白-胆红素分级和血小板计数临界值150,000/µL与肝细胞癌患者的高危静脉曲张显著相关。此外，修正的白蛋白-胆红素分级为1级或2a级且血小板>150,000/µL的肝细胞癌患者可能无需进行食管胃十二指肠镜检查。
