目的探讨AST和PLT比率指数(aspartate aminotransferase-to-platelet ratio index,APRI)联合血氨对肝硬化并肝性脑病(hepatic encephalopathy,HE)肝硬化患者诊断的价值。方法对48例无HE和48例伴有HE肝硬化患者分别进行AST、PLT和血氨检...目的探讨AST和PLT比率指数(aspartate aminotransferase-to-platelet ratio index,APRI)联合血氨对肝硬化并肝性脑病(hepatic encephalopathy,HE)肝硬化患者诊断的价值。方法对48例无HE和48例伴有HE肝硬化患者分别进行AST、PLT和血氨检测,并分析APRI、血氨值与HE之间的关系。结果伴有HE患者的Child分级和MELD评分均高于无HE者,差异有统计学意义(P<0.05)。APRI值在HE组的值为4.38±2.68,高于无HE组的2.19±1.75,差异有统计学意义(t=-4.721,P<0.001)。APRI值在不同HE分级中的分布:1级3.70±0.55、2级5.30±0.43、3~4级5.75±1.27,1级<2级<3~4级,差异有统计学意义(H=6.704,P=0.035)。血氨值在不同HE分级中的分布:1级(108.0±6.1)μg/dl、2级(130.4±23.4)μg/dl、3~4级(170.5±12.5)μg/dl,1级<2级<3~4级,差异有统计学意义(H=10.95,P=0.004)。APRI与血氨联合诊断HE时,ROC曲线下面积为0.898,敏感度为91.8%,特异度为96.9%。结论 APRI和血氨联合检测诊断HE效能较高,具有较好的临床应用价值。展开更多
Background: Chronic hepatitis C infection is common among people with history of substance use. Liver fibrosis assessment is a barrier to linkage to care, particularly among those with history of substance users. The ...Background: Chronic hepatitis C infection is common among people with history of substance use. Liver fibrosis assessment is a barrier to linkage to care, particularly among those with history of substance users. The use of non-invasive scores can be helpful in predicting liver cirrhosis in the era of HCV elimination, especially in countries where transient elastography(TE) is not available. We compared the commonly used non-invasive scores with a novel non-invasive score in predicting liver cirrhosis in this population. Methods: HCV patients with history of substance use between 2011 and 2016 were analyzed. All patients had TE for liver fibrosis assessment. Clinical performance of established non-invasive scores for fibrosis assessment and novel score were compared. Youden's index was used to determine optimal cut-off of the novel score. Results: A total of 579 patients were included. In multivariate logistic regression, cirrhosis on TE was associated with age( P = 0.002), aspartate aminotransferase(AST)( P = 0.004), and platelet count( P < 0.001), but not alanine aminotransferase(ALT)( P = 0.896). These form the components of modified AST-toplatelet ratio index(APRI) score. Modified APRI was superior to APRI in predicting cirrhosis(AUROC, 0.796 vs. 0.770, P = 0.007), but not fibrosis-4 score(FIB-4)( P = 1.00). Modified APRI at cut-off of 4 has sensitivity, specificity and negative predictive value(NPV) of 94.4%, 26.9% and 92.6%, respectively, and at 19, has sensitivity, specificity and positive predictive value(PPV) of 33.3%, 96.2% and 77.1%, respectively. FIB-4 has a NPV and PPV of 88.6%, 41.8% and 78.5%, 77.6%, at cut-off of 1.45 and 3.25, respectively. Using the cut-off of 4 and 14 for modified APRI, 32.5% of patients can be correctly classified and misses out only 5.6% of cirrhosis patients. Conclusions: Modified APRI score is superior in predicting cirrhosis in HCV population, with 32.5% of the population being correctly classified using cut-off of 4 and 14. Further studies are required to validate the findings.展开更多
Background:Primarily unresectable liver tumors may be approached by the Associating Liver Partition and Portal vein Ligation for Staged Hepatectomy(ALPPS)procedure.Post-hepatectomy liver failure(PHLF)poses the most si...Background:Primarily unresectable liver tumors may be approached by the Associating Liver Partition and Portal vein Ligation for Staged Hepatectomy(ALPPS)procedure.Post-hepatectomy liver failure(PHLF)poses the most significant risk factor for poor outcomes.The AST-to-platelets ratio index(APRI)/albumin-to-bilirubin index(ALBI)score has been proposed as an easy and routinely available score to monitor liver function.Here,we explored the predictive capability of the APRI/ALBI score to determine PHLF and perioperative morbidity to help determine the optimal timing of the 2nd stage of ALPPS.Methods:Based on the international multicenter ALPPS registry,patients from 2012 to 2020 with an available APRI/ALBI score were included.Postoperative outcomes clinically relevant PHLF B+C,90-day mortality,and severe morbidity(≥Clavien-Dindo 3b)after ALPPS stage II were assessed.The APRI/ALBI score was monitored perioperatively,and the predictive value was evaluated using logistic regression and receiver operating characteristics.Performance of APRI/ALBI score was compared to the ALPPS futility risk score in this cohort study.Results:Overall,464 patients from 16 participating centers were included.Clinically relevant PHLF(B+C)was observed in 7.5% of patients,of which 63% ultimately died.After stage I,the APRI/ALBI score gradually recovered.The pre-stage II APRI/ALBI score significantly predicted clinically relevant PHLF[area under the curve(AUC)=0.78;P<0.001],90-day mortality(AUC=0.67;P=0.002),and severe morbidity(AUC=0.65;P<0.001).Three clinically relevant APRI/ALBI score risk groups were defined:clinically relevant PHLF occurred in 3.1%in the low-,8.7%in the intermediate-,and 28.0%in the high-risk groups.90-day mortality was 6.8%in the low-,15.9% in the intermediate-,and 19.4%in the high-risk groups.Integrated assessment of the established futility risk score in combination with the APRI/ALBI score documented further increased predictive potential for clinically relevant PHLF(AUC 0.81;P<0.001).Conclusions:The APRI/ALBI score allows for simple and dynamic liver function recovery monitoring after the first ALPPS stage.Inadequate recovery of the APRI/ALBI score until ALPPS stage II was associated with PHLF B+C,90-day mortality,and severe morbidity.With the proposed risk model,optimized timing of the second stage of ALPPS may further increase the safety of this procedure.展开更多
Chronic liver disease(CLD)is prevalent in the United States and globally.It is a major source of mortality and morbidity with loss of productivity due to disability(1).Recent advances in the treatment of hepatitis C v...Chronic liver disease(CLD)is prevalent in the United States and globally.It is a major source of mortality and morbidity with loss of productivity due to disability(1).Recent advances in the treatment of hepatitis C virus(HCV)infection has led to some reduction in cirrhosis development from this etiology,however,increasing rates of alcohol use and metabolic dysfunction associated liver disease(MASLD)threaten to counter this progress(1).The progression of CLD to cirrhosis and its subsequent squeal-complications of portal hypertension such as esophageal varices,hepatic encephalopathy,and hepatocellular carcinoma(HCC)-accounts for much of the mortality and morbidity in patients with cirrhosis(2).For all these reasons,assessing patients with CLD for significant fibrosis is essential for early intervention to slow progression and reduce the incidence of these serious complications.展开更多
文摘Background: Chronic hepatitis C infection is common among people with history of substance use. Liver fibrosis assessment is a barrier to linkage to care, particularly among those with history of substance users. The use of non-invasive scores can be helpful in predicting liver cirrhosis in the era of HCV elimination, especially in countries where transient elastography(TE) is not available. We compared the commonly used non-invasive scores with a novel non-invasive score in predicting liver cirrhosis in this population. Methods: HCV patients with history of substance use between 2011 and 2016 were analyzed. All patients had TE for liver fibrosis assessment. Clinical performance of established non-invasive scores for fibrosis assessment and novel score were compared. Youden's index was used to determine optimal cut-off of the novel score. Results: A total of 579 patients were included. In multivariate logistic regression, cirrhosis on TE was associated with age( P = 0.002), aspartate aminotransferase(AST)( P = 0.004), and platelet count( P < 0.001), but not alanine aminotransferase(ALT)( P = 0.896). These form the components of modified AST-toplatelet ratio index(APRI) score. Modified APRI was superior to APRI in predicting cirrhosis(AUROC, 0.796 vs. 0.770, P = 0.007), but not fibrosis-4 score(FIB-4)( P = 1.00). Modified APRI at cut-off of 4 has sensitivity, specificity and negative predictive value(NPV) of 94.4%, 26.9% and 92.6%, respectively, and at 19, has sensitivity, specificity and positive predictive value(PPV) of 33.3%, 96.2% and 77.1%, respectively. FIB-4 has a NPV and PPV of 88.6%, 41.8% and 78.5%, 77.6%, at cut-off of 1.45 and 3.25, respectively. Using the cut-off of 4 and 14 for modified APRI, 32.5% of patients can be correctly classified and misses out only 5.6% of cirrhosis patients. Conclusions: Modified APRI score is superior in predicting cirrhosis in HCV population, with 32.5% of the population being correctly classified using cut-off of 4 and 14. Further studies are required to validate the findings.
文摘Background:Primarily unresectable liver tumors may be approached by the Associating Liver Partition and Portal vein Ligation for Staged Hepatectomy(ALPPS)procedure.Post-hepatectomy liver failure(PHLF)poses the most significant risk factor for poor outcomes.The AST-to-platelets ratio index(APRI)/albumin-to-bilirubin index(ALBI)score has been proposed as an easy and routinely available score to monitor liver function.Here,we explored the predictive capability of the APRI/ALBI score to determine PHLF and perioperative morbidity to help determine the optimal timing of the 2nd stage of ALPPS.Methods:Based on the international multicenter ALPPS registry,patients from 2012 to 2020 with an available APRI/ALBI score were included.Postoperative outcomes clinically relevant PHLF B+C,90-day mortality,and severe morbidity(≥Clavien-Dindo 3b)after ALPPS stage II were assessed.The APRI/ALBI score was monitored perioperatively,and the predictive value was evaluated using logistic regression and receiver operating characteristics.Performance of APRI/ALBI score was compared to the ALPPS futility risk score in this cohort study.Results:Overall,464 patients from 16 participating centers were included.Clinically relevant PHLF(B+C)was observed in 7.5% of patients,of which 63% ultimately died.After stage I,the APRI/ALBI score gradually recovered.The pre-stage II APRI/ALBI score significantly predicted clinically relevant PHLF[area under the curve(AUC)=0.78;P<0.001],90-day mortality(AUC=0.67;P=0.002),and severe morbidity(AUC=0.65;P<0.001).Three clinically relevant APRI/ALBI score risk groups were defined:clinically relevant PHLF occurred in 3.1%in the low-,8.7%in the intermediate-,and 28.0%in the high-risk groups.90-day mortality was 6.8%in the low-,15.9% in the intermediate-,and 19.4%in the high-risk groups.Integrated assessment of the established futility risk score in combination with the APRI/ALBI score documented further increased predictive potential for clinically relevant PHLF(AUC 0.81;P<0.001).Conclusions:The APRI/ALBI score allows for simple and dynamic liver function recovery monitoring after the first ALPPS stage.Inadequate recovery of the APRI/ALBI score until ALPPS stage II was associated with PHLF B+C,90-day mortality,and severe morbidity.With the proposed risk model,optimized timing of the second stage of ALPPS may further increase the safety of this procedure.
文摘Chronic liver disease(CLD)is prevalent in the United States and globally.It is a major source of mortality and morbidity with loss of productivity due to disability(1).Recent advances in the treatment of hepatitis C virus(HCV)infection has led to some reduction in cirrhosis development from this etiology,however,increasing rates of alcohol use and metabolic dysfunction associated liver disease(MASLD)threaten to counter this progress(1).The progression of CLD to cirrhosis and its subsequent squeal-complications of portal hypertension such as esophageal varices,hepatic encephalopathy,and hepatocellular carcinoma(HCC)-accounts for much of the mortality and morbidity in patients with cirrhosis(2).For all these reasons,assessing patients with CLD for significant fibrosis is essential for early intervention to slow progression and reduce the incidence of these serious complications.
