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CHESS-ALARM score to stratify decompensation risk in compensated advanced chronic liver disease patients: An
Yu Jun Wong1,2,3, Jia Li4, Chuan Liu5
1Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore.
Insights
A new CHESS-ALARM score accurately predicts liver decompensation in compensated advanced chronic liver disease (cACLD) patients. This score improves risk stratification compared to existing methods, aiding clinical decision-making for cACLD management.
Area of Science:
- Hepatology
- Medical Diagnostics
- Predictive Analytics
Background:
- Compensated advanced chronic liver disease (cACLD) patients face risks of liver decompensation.
- Existing criteria like PE criteria require validation and refinement for accurate risk prediction.
- Identifying cACLD patients at high risk is crucial for timely intervention.
Purpose of the Study:
- To validate and refine PE criteria for identifying cACLD patients at risk of decompensation.
- To develop and validate a novel predictive score for liver decompensation in Asian cACLD patients.
- To compare the accuracy of the new score against established models like MELD and ALBI-FIB-4.
Main Methods:
- An international cohort of 633 cACLD patients with liver stiffness measurement (LSM) and esophagogastroduodenoscopy data were analyzed.
- Competing risk analysis was used to predict the first liver decompensation, with death and hepatocellular carcinoma as competing events.
- A predictive model, the CHESS-ALARM score, was developed incorporating age, platelet count, gender, and LSM, and its accuracy was compared with MELD, ALBI, and ALBI-FIB-4 using time-dependent AUC.
Main Results:
- The CHESS-ALARM score demonstrated high accuracy (tAUC = 0.86) in predicting liver decompensation at 5 years, significantly outperforming MELD (tAUC: 0.61), ALBI (tAUC: 0.62), ALBI-FIB-4 (tAUC: 0.70), and LSM > 25 kPa (tAUC: 0.54).
- Patients with a CHESS-ALARM score ≥ -0.37 exhibited an 11-fold higher risk of decompensation.
- Favorable Baveno VI status effectively ruled out patients at risk, while LSM > 25 kPa alone was suboptimal for prediction.
Conclusions:
- The CHESS-ALARM score offers a robust and clinically applicable tool for estimating individual decompensation risk in cACLD patients.
- This score can enhance clinical practice by improving risk stratification and guiding management decisions.
- Further research is needed to evaluate the score's performance in morbidly obese cACLD patients with nonviral etiologies.
Background And Aim:
A combination of platelet and elastography (PE criteria) was proposed to identify compensated advanced chronic liver disease (cACLD) patients at risk of liver decompensation. We aim to validate and refine PE criteria by developing a new predictive score to predict decompensation in Asian cACLD patients.
Methods:
An international cohort of 633 cACLD patients with liver stiffness measurement (LSM) and esophagogastroduodenoscopy performed were included. We validated PE criteria to predict first liver decompensation using competing risk analysis, with death and hepatocellular carcinoma as competing events. We developed a predictive model using proportional subdistribution hazard regression. Prognostic accuracy was compared with the model of end-stage liver disease (MELD), albumin-bilirubin (ALBI), and ALBI-FIB-4 score using time-dependent area under operative characteristic curve (tAUC).
Results:
Sixty patients developed decompensation over the median follow-up of 39 months. Favorable Baveno VI status ruled out cACLD patients at risk of liver decompensation. LSM > 25 kPa was suboptimal to predict cACLD patients who will develop liver decompensation. We developed CHESS-ALARM score by incorporating age, platelet, and gender into LSM. CHESS-ALARM score (tAUC = 0.86, 95% confidence interval [CI]: 0.79-0.94) has significantly higher accuracy than MELD (tAUC: 0.61), ALBI (tAUC: 0.62), ALBI-FIB-4 (tAUC: 0.70), and LSM > 25 kPa (tAUC: 0.54) to predict liver decompensation at 5 years (P < 0.05 for all). Patients with CHESS-ALARM score ≥ -0.37 had an 11-fold higher risk of decompensation (subdistribution hazard ratio = 11.2, 95% CI: 5.1-24.5).
Conclusion:
CHESS-ALARM score can be readily incorporated into clinical practice of cACLD patients to estimate individual risk of liver decompensation; however, more data are required in morbidly obese cACLD patients of nonviral etiology.
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