Influential Factors And Prognostic Analysis Of Baveno ? Status Changes In Patients With Compensated Advanced Chronic Liver Disease After Antiviral Therapy

BackgroundCirrhosis of the liver has been the leading cause of death from liver diseases worldwide.The dynamic changes of liver cirrhosis can make the patient progress from the compensatory phase to the decompensated phase.Bleeding from esophageal and gastric fundus varices is one of the main causes of death in patients with decompensated liver cirrhosis.The 2015 Baveno ? consensus meeting proposed the concept of compensated advanced chronic liver disease(cACLD)instead of cirrhosis,and proposed that PLT>150×109/L and LSM<20 kPa meet the Baveno ? standard.The Baveno ? standard has been validated by a large number of studies as an effective non-invasive standard for screening high-risk varicose veins,and can be applied to identify patients at risk of decompensation in the population.Patients with viral hepatitis-related cirrhosis have also been confirmed that antiviral therapy can delay the progression of the disease and improve the prognosis.However,there are currently very few studies to observe the longitudinal changes of patients' Baveno ? status during antiviral treatment,independent predictors of changes in Baveno ? status,and the relationship between Baveno ?status changes and prognosis.The independent predictors that affect the status of Baveno ? will reduce the cost of gastroscope screening for varicose veins,and will be of guiding significance for the individualized management of patients with liver cirrhosis.ObjectiveThe purpose of this study was to investigate the effect of antiviral therapy on the status of Baveno ? in patients with compensatory advanced chronic liver disease,and to analyze the independent predictors of changes in Baveno ? status and the relationship between changes in Baveno ? status and prognosis.MethodsA retrospective collection of 261 patients who were diagnosed with chronic viral hepatitis in the outpatient or inpatient department of the Liver Disease Center of Nanfang Hospital of Southern Medical University from May 2006 to August 2020 and received antiviral therapy after receiving antiviral therapy.Each patient needs to be followed up at the following two points:the initial antiviral treatment and the last visit(as of February 2021).Record the clinical baseline data,imaging data,and invasive examination data(liver biopsy,electronic gastroduodenoscopy)of each node.Each node should judge whether it meets the Baveno ? standard according to the platelet and liver hardness value.Every patient needs two nodes to be able to judge whether they meet the Baveno ? standard.This study mainly observes the change of the patient's Baveno ? status from the initial antivial treatment to the last visit.There will be the following four statuses:compliant-compliant,compliant-non-compliant,non-compliant-non-complian t,and non-compliant-compliant.The improvement of Baveno ? status is the main ending,and the decompensation event is the secondary ending.First,the chi-square test is used to clarify the effect of antiviral therapy on the status of Baveno ?;then,the multi-factor Cox stepwise forward regression analysis method is used to screen out variables that can independently predict the improvement of Baveno VI status.The area under the ROC curve was used to evaluate the predictive value of the variable to the outcome and calculate the best cutoff value.Finally,group by the best cut-off value to observe the influence of variables on the improvement of Baveno VI and decompensation events.The SPSS(23.0)and MedCalc(19.2.0)were used for statistical analysis.A P-value of<0.05 was considered statistically significant.ResultsThe first part:After antiviral treatment,the number of patients with good Baveno ? status increased(?2=40.225,P<0.001).Compared with the group with good Baveno ? status at the first visit,the probability of decompensation events in the group with poor Baveno ? status was higher(?2=4.406,P=0.036).The second part:According to the Baveno ? status at the last follow-up,patients are divided into groups that can be waited for for gastroscopy screening and those that cannot be waited for.The results of Cox regression analysis showed that age(HR=0.974,95%CI:0.955-0.994,P=0.011),PLT(HR=1.009,95%CI:1.006-1.012,P<0.001)are waiting for gastroscopy screening Independent predictors.However,the maximum area under the ROC curve for age is 0.614(95%CI:0.545-0.684,P=0.002),and the predictive ability to wait for gastroscopy screening is poor,while PLT(AUC=0.882,95%CI:0.840-0.925,P<0.001)can wait for gastroscopy screening to have better predictive ability.Part 3:Divide patients with poor Baveno ? status at the first diagnosis into persistently poor Baveno ? status group and Baveno ? improved status group.Cox regression analysis showed that PLT(HR=1.011,95%CI:1.007-1.014,P<0.001)was an independent predictor of the improvement of Baveno VI.In addition,PLT(AUC=0.818,95%CI:0.758-0,879,P<0.001)has excellent predictive ability for the improvement of Baveno ?.The best cut-off value of PLT is 118.5×109/L.Compared with the PLT?120 G/L group,the PLT<120 G/L group had a higher probability of decompensation events(?2=7.879,P=0.005).Compared with the Baveno ? improvement group,the persistently poor Baveno ? status group had a higher probability of decompensation events(?2=8.550,P=0.004).ConclusionIn the study population,antiviral therapy can effectively improve the Baveno ?status of patients with cACLD and delay the progression of the disease;PLT is an independent predictor of changes in Baveno ? status;PLT<120 G/L and the continuous poor Baveno ? status during the course of the disease Patients are more likely to progress to adverse outcomes such as decompensated liver cirrhosis.It is recommended to strengthen follow-up to increase the detection rate;patients with poor Baveno ? status at the first diagnosis but PLT? 120 G/L can be appropriately reduced according to the actual situation.Check the frequency and save medical expenses.