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연구자들이 자신의 연구와 전문성을 널리 알리고, 새로운 협력의 기회를 만들 수 있는 네트워킹 공간이에요.
논문 기본 정보
- 자료유형
- 학술저널
- 저자정보
- 발행연도
- 2019.1
- 수록면
- 206 - 214 (9page)
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초록· 키워드
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Background/Aims: Acoustic radiation force impulse (ARFI) elastography predicts the presence of esophageal varices (EVs). We investigated whether an ARFI-based prediction model can assess EV bleeding (EVB) risk in patients with cirrhosis. Methods: The records of 262 patients with cirrhosis who underwent ARFI elastography and endoscopic surveillance at two institutions in 2008 to 2013 were retrospectively reviewed, and ARFI–spleen diameter-to-platelet ratio scores (ASPS) were calculated. Results: The median patient age (165 men, 97 women) was 56 years. The median ARFI velocity, spleen diameter, platelet count, and ASPS were 1.7 m/sec, 10.1 cm, 145×109/L, and 1.16, respectively. During the median 38-month follow-up, 61 patients experienced EVB. Among all patients (179 without EVs and 83 with EVs), the cutoff value that maximized the sum of the sensitivity (73.1%) and specificity (78.4%) (area under receiver operating characteristic curve [AUROC], 0.824) for predicting EVB was 2.60. The cumulative EVB incidence was significantly higher in patients with ASPS ≥2.60 than in those with ASPS <2.60 (p<0.001). Among patients with EVs (n=83), 49 had high-risk EVs (HEVs), and 22 had EVB. The cumulative EVB incidence was significantly higher in HEV patients than in low-risk EV patients (p=0.037). At an ASPS of 4.50 (sensitivity, 66.7%; specificity, 70.6%; AUROC, 0.691), the cumulative EVB incidence was significantly higher in patients with a high ASPS than in those with a low ASPS (p=0.045). A higher ASPS independently predicted EVB (hazard ratio, 4.072; p=0.047). Conclusions: ASPS can assess EVB risk in patients with cirrhosis. Prophylactic management should be considered for patients with HEVs and ASPS ≥4.50.
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참고문헌 (27)
참고문헌 신청
Garcia-Tsao G / 2017 / Portal hypertensive bleeding in cirrhosis : risk stratification, diagnosis, and management : 2016 practice guidance by the American Association for the study of liver diseases / Hepatology 65:310~335
Kovalak M / 2007 / Endoscopic screening for varices in cirrhotic patients : data from a national endoscopic database / Gastrointest Endosc 65:82~88
Groszmann RJ / 2005 / Beta-blockers to prevent gastroesophageal varices in patients with cirrhosis / N Engl J Med 353:2254~2261
Merli M / 2003 / Incidence and natural history of small esophageal varices in cirrhotic patients / J Hepatol 38:266~272
North Italian Endoscopic Club for the Study / 1988 / Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study / N Engl J Med 319:983~989
Kovalak M / 2007 / Endoscopic screening for varices in cirrhotic patients : data from a national endoscopic database / Gastrointest Endosc 65:82~88
Groszmann RJ / 2005 / Beta-blockers to prevent gastroesophageal varices in patients with cirrhosis / N Engl J Med 353:2254~2261
Merli M / 2003 / Incidence and natural history of small esophageal varices in cirrhotic patients / J Hepatol 38:266~272
North Italian Endoscopic Club for the Study / 1988 / Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study / N Engl J Med 319:983~989
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