Li Yan-Qiu, Li Yong-Qi, Li Jin-Ze, Zhu Bing-Bing, Lu Yu, Feng Ying, Wang Xian-Bo
Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China.
Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100037, China.
World J Hepatol. 2025 Aug 27;17(8):109796. doi: 10.4254/wjh.v17.i8.109796.
Clinically significant portal hypertension (CSPH) is a crucial prognostic determinant for liver-related events (LREs) in patients with compensated viral cirrhosis. Liver stiffness measurement (LSM)-related markers may help to predict the risk of LREs.
To evaluate the value of LSM and its composite biomarkers [LSM-platelet ratio (LPR), LSM-albumin ratio (LAR)] in predicting LREs.
This study retrospectively enrolled compensated viral cirrhosis patients with CSPH. The Cox regression model was employed to examine the prediction of LSM, LPR, and LAR for LREs. The model performance was assessed through receiver operating characteristic, decision curve, and time-dependent area under the curve analysis. The Kaplan-Meier curve was used to evaluate the cumulative incidence of LREs, and further stratified analysis of different LREs was performed.
A total of 598 patients were included, and 319 patients (53.3%) developed LREs during follow-up. Multivariate proportional hazards modeling demonstrated that LSM, LPR, and LAR were independent predictors of LREs. LPR had better performance in predicting LREs than LAR and LSM (area under the curve = 0.780, 0.727, 0.683, respectively, all < 0.05). The cumulative incidence of LREs in the high-risk group were significantly higher than that in the low-risk group ( < 0.001). Among the different LREs, LPR was superior to LSM and LAR in predicting liver decompensation, while the difference in predicting hepatocellular carcinoma and liver-related death was relatively small.
LPR is superior to LSM and LAR in predicting LREs in compensated viral cirrhosis patients with CSPH, especially in predicting liver decompensation.
临床上显著的门静脉高压（CSPH）是代偿期病毒性肝硬化患者肝脏相关事件（LREs）的关键预后决定因素。肝脏硬度测量（LSM）相关标志物可能有助于预测LREs的风险。
评估LSM及其复合生物标志物[LSM-血小板比值（LPR）、LSM-白蛋白比值（LAR）]在预测LREs中的价值。
本研究回顾性纳入了患有CSPH的代偿期病毒性肝硬化患者。采用Cox回归模型检验LSM、LPR和LAR对LREs的预测作用。通过受试者工作特征曲线、决策曲线和曲线下时间依赖性面积分析评估模型性能。采用Kaplan-Meier曲线评估LREs的累积发生率，并对不同的LREs进行进一步分层分析。
共纳入598例患者，319例患者（53.3%）在随访期间发生了LREs。多变量比例风险模型表明，LSM、LPR和LAR是LREs的独立预测因素。LPR在预测LREs方面的表现优于LAR和LSM（曲线下面积分别为0.780、0.727、0.683，均<0.05）。高风险组LREs的累积发生率显著高于低风险组（<0.001）。在不同的LREs中，LPR在预测肝失代偿方面优于LSM和LAR，而在预测肝细胞癌和肝脏相关死亡方面的差异相对较小。
在患有CSPH的代偿期病毒性肝硬化患者中，LPR在预测LREs方面优于LSM和LAR，尤其是在预测肝失代偿方面。
