A Novel SAVE Score to Stratify Decompensation Risk in Compensated Advanced Chronic Liver Disease (CHESS2102): An International Multicenter Cohort Study

In patients with compensated advanced chronic liver disease (cACLD), the invasive measurement of hepatic venous pressure gradient is the best predictor of hepatic decompensation. This study aimed at developing an alternative risk prediction model to provide a decompensation risk assessment in cACLD....

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Vydáno v:	The American journal of gastroenterology Ročník 117; číslo 10; s. 1605 - 1613
Hlavní autoři:	Liu, Chuan, Cao, Zhujun, Yan, Huadong, Wong, Yu Jun, Xie, Qing, Hirooka, Masashi, Enomoto, Hirayuki, Kim, Tae Hyung, Hanafy, Amr Shaaban, Liu, Yanna, Huang, Yifei, Li, Xiaoguo, Kang, Ning, Koizumi, Yohei, Hiasa, Yoichi, Nishimura, Takashi, Iijima, Hiroko, Jung, Young Kul, Yim, Hyung Joon, Guo, Ying, Zhang, Linpeng, Ma, Jianzhong, Kumar, Manoj, Jindal, Ankur, Teh, Kok Ban, Sarin, Shiv Kumar, Qi, Xiaolong
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	United States Wolters Kluwer 01.10.2022 Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
Témata:	Accuracy Albumins Ascites Cohort analysis Cohort Studies Elasticity Imaging Techniques Endoscopy Etiology Gastroenterology Hepatitis Humans Hypertension Hypertension, Portal - etiology Liver Liver cancer Liver Cirrhosis - complications Liver diseases Mortality Patients Predictive Value of Tests Retrospective Studies Risk factors Statistical analysis Surveillance Variables China India
ISSN:	0002-9270, 1572-0241, 1572-0241
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Abstract	In patients with compensated advanced chronic liver disease (cACLD), the invasive measurement of hepatic venous pressure gradient is the best predictor of hepatic decompensation. This study aimed at developing an alternative risk prediction model to provide a decompensation risk assessment in cACLD. Patients with cACLD were retrospectively included from 9 international centers within the Portal Hypertension Alliance in China (CHESS) network. Baseline variables from a Japanese cohort of 197 patients with cACLD were examined and fitted a Cox hazard regression model to develop a specific score for predicting hepatic decompensation. The novel score was validated in an external cohort (n = 770) from 5 centers in China, Singapore, Korea, and Egypt, and was further assessed for the ability of predicting clinically significant portal hypertension in a hepatic venous pressure gradient cohort (n = 285). In the derivation cohort, independent predictors of hepatic decompensation were identified including Stiffness of liver, Albumin, Varices, and platElets and fitted to develop the novel score, termed "SAVE" score. This score performed significantly better (all P < 0.05) than other assessed methods with a time-dependent receiver operating characteristic curve of 0.89 (95% confidence interval [CI]: 0.83-0.94) and 0.83 (95% CI: 0.73-0.92) in the derivation and validation cohorts, respectively. The decompensation risk was best stratified by the cutoff values at -6 and -4.5. The 5-year cumulative incidences of decompensation were 0%, 24.9%, and 69.0% in the low-risk, middle-risk, and high-risk groups, respectively ( P < 0.001). The SAVE score also accurately predicted clinically significant portal hypertension (AUC, 0.85 95% CI: 0.80-0.90). The SAVE score can be readily incorporated into clinical practice to accurately predict the individual risk of hepatic decompensation in cACLD.
AbstractList	In patients with compensated advanced chronic liver disease (cACLD), the invasive measurement of hepatic venous pressure gradient is the best predictor of hepatic decompensation. This study aimed at developing an alternative risk prediction model to provide a decompensation risk assessment in cACLD.INTRODUCTIONIn patients with compensated advanced chronic liver disease (cACLD), the invasive measurement of hepatic venous pressure gradient is the best predictor of hepatic decompensation. This study aimed at developing an alternative risk prediction model to provide a decompensation risk assessment in cACLD.Patients with cACLD were retrospectively included from 9 international centers within the Portal Hypertension Alliance in China (CHESS) network. Baseline variables from a Japanese cohort of 197 patients with cACLD were examined and fitted a Cox hazard regression model to develop a specific score for predicting hepatic decompensation. The novel score was validated in an external cohort (n = 770) from 5 centers in China, Singapore, Korea, and Egypt, and was further assessed for the ability of predicting clinically significant portal hypertension in a hepatic venous pressure gradient cohort (n = 285).METHODSPatients with cACLD were retrospectively included from 9 international centers within the Portal Hypertension Alliance in China (CHESS) network. Baseline variables from a Japanese cohort of 197 patients with cACLD were examined and fitted a Cox hazard regression model to develop a specific score for predicting hepatic decompensation. The novel score was validated in an external cohort (n = 770) from 5 centers in China, Singapore, Korea, and Egypt, and was further assessed for the ability of predicting clinically significant portal hypertension in a hepatic venous pressure gradient cohort (n = 285).In the derivation cohort, independent predictors of hepatic decompensation were identified including Stiffness of liver, Albumin, Varices, and platElets and fitted to develop the novel score, termed "SAVE" score. This score performed significantly better (all P < 0.05) than other assessed methods with a time-dependent receiver operating characteristic curve of 0.89 (95% confidence interval [CI]: 0.83-0.94) and 0.83 (95% CI: 0.73-0.92) in the derivation and validation cohorts, respectively. The decompensation risk was best stratified by the cutoff values at -6 and -4.5. The 5-year cumulative incidences of decompensation were 0%, 24.9%, and 69.0% in the low-risk, middle-risk, and high-risk groups, respectively ( P < 0.001). The SAVE score also accurately predicted clinically significant portal hypertension (AUC, 0.85 95% CI: 0.80-0.90).RESULTSIn the derivation cohort, independent predictors of hepatic decompensation were identified including Stiffness of liver, Albumin, Varices, and platElets and fitted to develop the novel score, termed "SAVE" score. This score performed significantly better (all P < 0.05) than other assessed methods with a time-dependent receiver operating characteristic curve of 0.89 (95% confidence interval [CI]: 0.83-0.94) and 0.83 (95% CI: 0.73-0.92) in the derivation and validation cohorts, respectively. The decompensation risk was best stratified by the cutoff values at -6 and -4.5. The 5-year cumulative incidences of decompensation were 0%, 24.9%, and 69.0% in the low-risk, middle-risk, and high-risk groups, respectively ( P < 0.001). The SAVE score also accurately predicted clinically significant portal hypertension (AUC, 0.85 95% CI: 0.80-0.90).The SAVE score can be readily incorporated into clinical practice to accurately predict the individual risk of hepatic decompensation in cACLD.DISCUSSIONThe SAVE score can be readily incorporated into clinical practice to accurately predict the individual risk of hepatic decompensation in cACLD. In patients with compensated advanced chronic liver disease (cACLD), the invasive measurement of hepatic venous pressure gradient is the best predictor of hepatic decompensation. This study aimed at developing an alternative risk prediction model to provide a decompensation risk assessment in cACLD. Patients with cACLD were retrospectively included from 9 international centers within the Portal Hypertension Alliance in China (CHESS) network. Baseline variables from a Japanese cohort of 197 patients with cACLD were examined and fitted a Cox hazard regression model to develop a specific score for predicting hepatic decompensation. The novel score was validated in an external cohort (n = 770) from 5 centers in China, Singapore, Korea, and Egypt, and was further assessed for the ability of predicting clinically significant portal hypertension in a hepatic venous pressure gradient cohort (n = 285). In the derivation cohort, independent predictors of hepatic decompensation were identified including Stiffness of liver, Albumin, Varices, and platElets and fitted to develop the novel score, termed "SAVE" score. This score performed significantly better (all P < 0.05) than other assessed methods with a time-dependent receiver operating characteristic curve of 0.89 (95% confidence interval [CI]: 0.83-0.94) and 0.83 (95% CI: 0.73-0.92) in the derivation and validation cohorts, respectively. The decompensation risk was best stratified by the cutoff values at -6 and -4.5. The 5-year cumulative incidences of decompensation were 0%, 24.9%, and 69.0% in the low-risk, middle-risk, and high-risk groups, respectively ( P < 0.001). The SAVE score also accurately predicted clinically significant portal hypertension (AUC, 0.85 95% CI: 0.80-0.90). The SAVE score can be readily incorporated into clinical practice to accurately predict the individual risk of hepatic decompensation in cACLD. INTRODUCTION:In patients with compensated advanced chronic liver disease (cACLD), the invasive measurement of hepatic venous pressure gradient is the best predictor of hepatic decompensation. This study aimed at developing an alternative risk prediction model to provide a decompensation risk assessment in cACLD.METHODS:Patients with cACLD were retrospectively included from 9 international centers within the Portal Hypertension Alliance in China (CHESS) network. Baseline variables from a Japanese cohort of 197 patients with cACLD were examined and fitted a Cox hazard regression model to develop a specific score for predicting hepatic decompensation. The novel score was validated in an external cohort (n = 770) from 5 centers in China, Singapore, Korea, and Egypt, and was further assessed for the ability of predicting clinically significant portal hypertension in a hepatic venous pressure gradient cohort (n = 285).RESULTS:In the derivation cohort, independent predictors of hepatic decompensation were identified including Stiffness of liver, Albumin, Varices, and platElets and fitted to develop the novel score, termed “SAVE” score. This score performed significantly better (all P < 0.05) than other assessed methods with a time-dependent receiver operating characteristic curve of 0.89 (95% confidence interval [CI]: 0.83–0.94) and 0.83 (95% CI: 0.73–0.92) in the derivation and validation cohorts, respectively. The decompensation risk was best stratified by the cutoff values at −6 and −4.5. The 5-year cumulative incidences of decompensation were 0%, 24.9%, and 69.0% in the low-risk, middle-risk, and high-risk groups, respectively (P < 0.001). The SAVE score also accurately predicted clinically significant portal hypertension (AUC, 0.85 95% CI: 0.80–0.90).DISCUSSION:The SAVE score can be readily incorporated into clinical practice to accurately predict the individual risk of hepatic decompensation in cACLD. In patients with compensated advanced chronic liver disease (cACLD), the invasive measurement of hepatic venous pressure gradient is the best predictor of hepatic decompensation. This study aimed at developing an alternative risk prediction model to provide a decompensation risk assessment in cACLD.
Author	Hiasa, Yoichi Jung, Young Kul Liu, Yanna Guo, Ying Liu, Chuan Sarin, Shiv Kumar Kim, Tae Hyung Hirooka, Masashi Yan, Huadong Zhang, Linpeng Koizumi, Yohei Wong, Yu Jun Nishimura, Takashi Kang, Ning Enomoto, Hirayuki Iijima, Hiroko Hanafy, Amr Shaaban Xie, Qing Huang, Yifei Kumar, Manoj Yim, Hyung Joon Ma, Jianzhong Jindal, Ankur Li, Xiaoguo Cao, Zhujun Qi, Xiaolong Teh, Kok Ban
AuthorAffiliation	Department of Infectious Disease, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Matsuyama, Japan Department of Interventional Radiology, The Third People's Hospital of Taiyuan, Taiyuan, China Department of Hepatology, The Third People's Hospital of Taiyuan, Taiyuan, China Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Japan Division of Gastroenterology, Hepatology and Endoscopy, Internal Medicine, Zagazig University Faculty of Medicine, Egypt Department of Infectious Disease, Shulan Hospital, Hangzhou, China Division of Gastroenterology and Hepatology, Korea University Ansan Hospital, Ansan-si, Gyeonggi-do, Republic of Korea Department of Hepatology, Institute of Liver and Biliary Sciences (ILBS), New Delhi, India CHESS Center, Center of Portal Hypertension, Department of Radiology, Zhongda Hospit
AuthorAffiliation_xml	– name: Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Matsuyama, Japan – name: Department of Hepatology, Institute of Liver and Biliary Sciences (ILBS), New Delhi, India – name: Department of Infectious Disease, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China – name: Division of Gastroenterology and Hepatology, Korea University Ansan Hospital, Ansan-si, Gyeonggi-do, Republic of Korea – name: CHESS Center, Center of Portal Hypertension, Department of Radiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China – name: Department of Hepatology, The Third People's Hospital of Taiyuan, Taiyuan, China – name: Division of Gastroenterology, Hepatology and Endoscopy, Internal Medicine, Zagazig University Faculty of Medicine, Egypt – name: Department of Infectious Disease, Shulan Hospital, Hangzhou, China – name: Department of Interventional Radiology, The Third People's Hospital of Taiyuan, Taiyuan, China – name: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Japan
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Copyright	Wolters Kluwer Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology. Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology 2022
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PublicationDate_xml	– month: 10 year: 2022 text: 2022-October-01 day: 01
PublicationDecade	2020
PublicationPlace	United States
PublicationPlace_xml	– name: United States – name: New York – name: Philadelphia, PA
PublicationTitle	The American journal of gastroenterology
PublicationTitleAlternate	Am J Gastroenterol
PublicationYear	2022
Publisher	Wolters Kluwer Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
Publisher_xml	– name: Wolters Kluwer – name: Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
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Snippet	In patients with compensated advanced chronic liver disease (cACLD), the invasive measurement of hepatic venous pressure gradient is the best predictor of... INTRODUCTION:In patients with compensated advanced chronic liver disease (cACLD), the invasive measurement of hepatic venous pressure gradient is the best...
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SubjectTerms	Accuracy Albumins Ascites Cohort analysis Cohort Studies Elasticity Imaging Techniques Endoscopy Etiology Gastroenterology Hepatitis Humans Hypertension Hypertension, Portal - etiology Liver Liver cancer Liver Cirrhosis - complications Liver diseases Mortality Patients Predictive Value of Tests Retrospective Studies Risk factors Statistical analysis Surveillance Variables
Title	A Novel SAVE Score to Stratify Decompensation Risk in Compensated Advanced Chronic Liver Disease (CHESS2102): An International Multicenter Cohort Study
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