美国肝硬化患者的疾病发展轨迹和竞争风险
Mohsen Mohammadi1,2, Bima J Hasjim1, Salva N Balbale3,4,5
1Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Northwestern University, Chicago, IL, United States of America.
PloS one
|February 14, 2025
概括
肝硬化进展显著增加死亡风险,晚期的死亡率高于以前报告的. 早期肝移植 (LT) 转诊对于肝病晚期的患者至关重要.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 临床流行病学临床流行病学
- 生存分析的分析.
背景情况:
- 肝硬化是一种进展性肝病,死亡率不断增加.
- 肝衰竭并发症显著导致发病率和死亡率.
- 精确的肝硬化分期对于及时干预和肝移植 (LT) 的考虑至关重要.
研究的目的:
- 开发和验证一种用于肝硬化进展的新型分期系统.
- 评估肝硬化阶段与死亡风险之间的关联.
- 为临床实践提供有关LT转诊和等待名单的信息.
主要方法:
- 追溯,纵向的人口-队列研究 (2006-2012).
- 根据临床诊断 (ICD-9,CPT代码) 和并发症,定义了肝硬化阶段.
- 使用多变量细灰竞争风险生存分析.
主要成果:
- 一个5个阶段的肝硬化进展框架适用于12,196名患者.
- 一年死亡率随着每个阶段的增加而增加,在第五阶段 (≥2并发症) 达到43.8%.
- 与第一阶段相比,第3阶段 (水出血),第4b阶段 () 和第5阶段的死亡风险明显较高.
结论:
- 即使是补偿性肝硬化 (第一阶段) 一年死亡率为7.3%,高于之前报告的1%.
- 死亡风险随着脱补偿性并发症,特别是多重并发症的增加而升级.
- 晚期肝硬化患者比接受LT的患者面临更高的死亡风险,这强调了早期LT转诊和等待名单的必要性.
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