补偿性晚期慢性肝病中肝损失补偿的预测模型:系统性审查
Vincent Haghnejad1,2,3, Laura Burke1,4, Siham El Ouahabi5
1Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom.
Hepatology (Baltimore, Md.)
|April 22, 2025
概括
在晚期慢性肝病 (cACLD) 中预测肝损伤是具有挑战性的. 目前的模型往往缺乏外部验证,描述不佳,限制了它们在临床上用于个性化治疗的使用.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 临床预测建模模型
- 慢性肝病研究 慢性肝病研究
背景情况:
- 确定处于脱补偿风险的补偿晚期慢性肝病 (cACLD) 患者对于个性化治疗至关重要.
- 存在许多多变量模型来预测脱补偿,但它们的性能和临床效用需要进行系统的评估.
- 这项研究的重点是评估已发表的模型,以预测cACLD患者的第一个脱补偿事件.
研究的目的:
- 系统地评估预测cACLD患者第一个脱补偿的多变量模型的性能和临床应用.
- 评估偏差风险和现有预测模型的适用性.
- 确定这些模型临床实用性和普及的障碍.
主要方法:
- 在MEDLINE上进行了一项系统的文献搜索,对到2023年12月的肝脏衰竭预测模型进行了系统的搜索.
- 模型偏差风险和适用性使用预测研究风险偏差评估工具 (PROBAST) 进行评估.
- 结果使用叙事合成进行了合成,遵循PRISMA和批判性评估指南.
主要成果:
- 包括16项研究,其中7项专注于单一病因;没有一个专门针对与酒精相关的肝病 (ArLD).
- 常见的预测因素包括白蛋白,血小板,年龄,肝硬度,胆红素,INR,以及门高血压的内镜检测结果.
- 13项研究的总体偏差风险很高,外部验证很少 (9/16项研究).
结论:
- 已发表的用于预测cACLD中脱补偿的模型通常描述不佳,缺乏强大的外部验证.
- 对ARLD患者的有限纳入和结果的不同定义影响了模型的概括性.
- 这些局限性阻碍了对cACLD脱补偿的预测模型的临床实用性和广泛采用.
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