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Risk and predictors of hepatic decompensation in grey zone patients by the Baveno VII criteria: A competing risk analysis

Authors
 Huapeng Lin  ;  Jimmy Che-To Lai  ;  Grace Lai-Hung Wong  ;  Adèle Delamarre  ;  Sang Hoon Ahn  ;  Guanlin Li  ;  Beom Kyung Kim  ;  Lilian Yan Liang  ;  Hye Won Lee  ;  Sherlot Juan Song  ;  Henry Lik-Yuen Chan  ;  Vincent Wai-Sun Wong  ;  Victor de Lédinghen  ;  Seung Up Kim  ;  Terry Cheuk-Fung Yip 
Citation
 ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Vol.58(9) : 920-928, 2023-11 
Journal Title
ALIMENTARY PHARMACOLOGY & THERAPEUTICS
ISSN
 0269-2813 
Issue Date
2023-11
Keywords
Baveno VII ; compensated advanced chronic liver disease ; competing risk analysis ; spleen stiffness measurement
Abstract
Background: Baveno VII was proposed for non-invasive identification of clinically significant portal hypertension. However, a substantial proportion of patients is classified in the grey zone (i.e., liver stiffness 15-24.9 kPa and/or platelet count <150 × 109 /L).

Aims: To evaluate the risk and predictors of hepatic decompensation in patients in the grey zone, and to determine the prognostic role of spleen stiffness measurement.

Methods: We included prospective cohorts (from Hong Kong, Korea and France) of patients who had undergone transient elastography examination for chronic liver disease. We estimated risk of hepatic decompensation using competing risk regression with hepatocellular carcinoma and non-liver-related death as competing events.

Results: We identified 2763 patients with compensated advanced chronic liver disease (cACLD). There were 1243 (44.9%) and 536 (19.4%) patients in the Baveno VII grey zone and high-risk groups, respectively. The cumulative incidence of decompensation at 5 years was significantly different among low-risk (0.6% [95% CI: 0.2%-1.3%]), grey zone 4.2% (95% CI: 3.1%-5.4%) and high-risk groups (11.4% [95% CI: 8.7%-14.6%]). By competing risk analysis, aetiology of liver disease (alcohol-related liver disease), albumin-bilirubin score and alkaline phosphatase level were independently associated with decompensation among patients in the grey zone. The combination of Baveno VII and spleen stiffness significantly reduced patients classified into grey zone (12.8% in cACLD patients), while maintaining high discrimination of decompensation in low- and high-risk groups.

Conclusions: Patients in grey zone of Baveno VII criteria remain at high risk of hepatic decompensation. Clinical risk factors and spleen stiffness can further stratify the risk in such patients.
Full Text
https://onlinelibrary.wiley.com/doi/10.1111/apt.17699
DOI
10.1111/apt.17699
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Beom Kyung(김범경) ORCID logo https://orcid.org/0000-0002-5363-2496
Kim, Seung Up(김승업) ORCID logo https://orcid.org/0000-0002-9658-8050
Ahn, Sang Hoon(안상훈) ORCID logo https://orcid.org/0000-0002-3629-4624
Lee, Hye Won(이혜원) ORCID logo https://orcid.org/0000-0002-3552-3560
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/196718
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