期刊
HEPATOLOGY INTERNATIONAL
卷 16, 期 3, 页码 669-679出版社
SPRINGER
DOI: 10.1007/s12072-021-10293-5
关键词
Pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome; Hepatic veno-occlusive disease; Anticoagulation; Prognosis; Disease severity; Acute portal hypertension; Portal vein velocity; Drum Tower Severity Scoring System; Gynura segetum; Drug-induced liver injury
资金
- Nanjing Medical Science and Technique Development Foundation [ZKX19015]
This study aimed to create a novel severity scoring system (DTSS) for patients with pyrrolizidine alkaloid (PA)-induced hepatic sinusoidal obstruction syndrome (HSOS) to guide therapy. Through analysis and validation, a predictive DTSS system was established for accurate prediction of the outcome of supportive care and anticoagulation therapy.
Background and aims There has been no reliable severity system based on the prognosis to guide therapeutic strategies for patients with pyrrolizidine alkaloid (PA)-induced hepatic sinusoidal obstruction syndrome (HSOS). We aimed to create a novel Drum Tower Severity Scoring (DTSS) system for these patients to guide therapy. Methods 172 Patients with PA-HSOS who received supportive care and anticoagulation therapy in Nanjing Drum Tower Hospital from January 2008 to December 2020 were enrolled and analyzed retrospectively. These patients were randomized into a training or validation set in a 3:1 ratio. Next, we established and validated the newly developed DTSS system. Results Analysis identified a predictive formula: logit (P) = 0.004 x aspartate aminotransferase (AST, U/L) + 0.019 x total bilirubin (TB, mu mol/L) - 0.571 x fibrinogen (FIB, g/L) - 0.093 x peak portal vein velocity (PVV, cm/s) + 1.122. Next, we quantified the above variables to establish the DTSS system. For the training set, the area under the ROC curve (AUC) (n = 127) was 0.787 [95% confidence interval (CI) 0.706-0.868; p < 0.001]. With a lower cut-off value of 6.5, the sensitivity and negative predictive value for predicting no response to supportive care and anticoagulation therapy were 94.7% and 88.0%, respectively. When applying a high cut-off value of 10.5, the specificity was 92.9% and the positive predictive value was 78.3%. For the validation set, the system performed stable with an AUC of 0.808. Conclusions The DTSS system can predict the outcome of supportive care and anticoagulation in PA-HSOS patients with satisfactory accuracy by evaluating severity, and may have potential significance for guiding therapy.
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