J Hepatol. 2019;70(3):412-422.
Non-invasive response prediction in prophylactic carvedilol therapy for cirrhotic patients with esophageal varices.
제1저자 김휘영, 소영호 · 교신저자 김원
소속 (6)
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea.
- Department of Radiology, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea.
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea. Electronic address: drwon1@snu.ac.kr.
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea.
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA.
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
Abstract
BACKGROUND & AIMS Non-selective beta-blockers (NSBBs) are the mainstay of primary prophylaxis of esophageal variceal bleeding in patients with liver cirrhosis. We investigated whether non-invasive markers of portal hypertension correlate with hemodynamic responses to NSBBs in cirrhotic patients with esophageal varices.
METHODS In this prospective cohort study, 106 cirrhotic patients with high-risk esophageal varices in the derivation cohort received carvedilol prophylaxis, and completed paired measurements of hepatic venous pressure gradient, liver stiffness (LS), and spleen stiffness (SS) at the beginning and end of dose titration. LS and SS were measured using acoustic radiation force impulse imaging. A prediction model for hemodynamic response was derived, and subject to an external validation in the validation cohort (63 patients).
RESULTS Hemodynamic response occurred in 59 patients (55.7%) in the derivation cohort, and in 33 patients (52.4%) in the validation cohort, respectively. Multivariate logistic regression analysis identified that ΔSS was the only significant predictor of hemodynamic response (odds ratio 0.039; 95% confidence interval 0.008-0.135; p <0.0001). The response prediction model (ModelΔSS = 0.0490-2.8345 × ΔSS; score = (exp[ModelΔSS])/(1 + exp[ModelΔSS]) showed good predictive performance (area under the receiver-operating characteristic curve [AUC] = 0.803) using 0.530 as the threshold value. The predictive performance of the ModelΔSS in the validation set improved using the same threshold value (AUC = 0.848).
CONCLUSION A new model based on dynamic changes in SS exhibited good performance in predicting hemodynamic response to NSBB prophylaxis in patients with high-risk esophageal varices.
LAY SUMMARY Non-selective beta-blockers are the mainstay of primary prophylaxis to prevent variceal bleeding in patients with cirrhosis and high-risk esophageal varices. This prospective study showed that a prediction model based on changes in spleen stiffness before vs. after dose titration might be a non-invasive marker for response to prophylactic non-selective beta-blocker (carvedilol) therapy in patients with cirrhosis and high-risk esophageal varices. ClinicalTrials.gov Identifier: NCT01943318.
Copyright © 2018 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
Keywords
Beta-blockerElastographyHemodynamic responsePortal hypertension
그 밖의 정보
- 출판 형태
- Journal Article, Research Support, Non-U.S. Gov't
- 저널
- Journal of hepatology · eISSN 1600-0641
- 전자 출판
- 2018-10-31
- MeSH
- Adrenergic beta-Antagonists / administration & dosage · Carvedilol / administration & dosage · Chemoprevention / methods · Clinical Decision Rules · Elasticity Imaging Techniques / methods · Esophageal and Gastric Varices* / etiology / prevention & control · Female · Gastrointestinal Hemorrhage* / etiology / prevention & control · Hemodynamics / drug effects · Humans · Hypertension, Portal* / diagnosis / etiology / physiopathology · Liver / pathology · Liver Cirrhosis* / complications / diagnosis / drug therapy / physiopathology · Male · Middle Aged · Reproducibility of Results · Spleen / pathology
- Substances
- Adrenergic beta-Antagonists · Carvedilol
- 데이터
- ClinicalTrials.gov: NCT01943318