{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:48:44Z","timestamp":1790790524634,"version":"4.1.0"},"reference-count":23,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2022,1,12]],"date-time":"2022-01-12T00:00:00Z","timestamp":1641945600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,1,12]],"date-time":"2022-01-12T00:00:00Z","timestamp":1641945600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100019349","name":"Nanjing Medical Science and Technique Development Foundation","doi-asserted-by":"crossref","award":["NO. ZKX19015"],"award-info":[{"award-number":["NO. ZKX19015"]}],"id":[{"id":"10.13039\/501100019349","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Hepatol Int"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background and aims<\/jats:title>\n                <jats:p>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.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>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.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Analysis identified a predictive formula: logit (<jats:italic>P<\/jats:italic>)\u2009=\u20090.004\u2009\u00d7\u2009aspartate aminotransferase (AST, U\/L)\u2009+\u20090.019\u2009\u00d7\u2009total bilirubin (TB, \u03bcmol\/L)\u00a0\u2212\u00a00.571\u2009\u00d7\u2009fibrinogen (FIB, g\/L)\u00a0\u2212\u00a00.093\u2009\u00d7\u2009peak portal vein velocity (PVV, cm\/s)\u2009+\u20091.122. Next, we quantified the above variables to establish the DTSS system. For the training set, the area under the ROC curve (AUC) (<jats:italic>n<\/jats:italic>\u2009=\u2009127) was 0.787 [95% confidence interval (CI) 0.706\u20130.868; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001]. 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.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>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.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s12072-021-10293-5","type":"journal-article","created":{"date-parts":[[2022,1,12]],"date-time":"2022-01-12T20:10:06Z","timestamp":1642018206000},"page":"669-679","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Development of a Drum Tower Severity Scoring (DTSS) system for pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome"],"prefix":"10.1007","volume":"16","author":[{"given":"Xuan","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiangqiang","family":"Xiao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qin","family":"Yin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Han","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taishun","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ge","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3829-5831","authenticated-orcid":false,"given":"Yuzheng","family":"Zhuge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,1,12]]},"reference":[{"issue":"8","key":"10293_CR1","doi-asserted-by":"publisher","first-page":"1212","DOI":"10.1038\/s41401-020-00553-9","volume":"42","author":"L Zhu","year":"2021","unstructured":"Zhu L, Zhang CY, Li DP, et al. Tu-San-Qi (Gynura japonica): the culprit behind pyrrolizidine alkaloid-induced liver injury in China. Acta Pharmacol Sin 2021;42(8):1212\u20131222. https:\/\/doi.org\/10.1038\/s41401-020-00553-9","journal-title":"Acta Pharmacol Sin"},{"issue":"28","key":"10293_CR2","doi-asserted-by":"publisher","first-page":"3753","DOI":"10.3748\/wjg.v25.i28.3753","volume":"25","author":"XQ Yang","year":"2019","unstructured":"Yang XQ, Ye J, Li X, et al. Pyrrolizidine alkaloids-induced hepatic sinusoidal obstruction syndrome: pathogenesis, clinical manifestations, diagnosis, treatment, and outcomes. World J Gastroenterol 2019;25(28):3753\u20133763. https:\/\/doi.org\/10.3748\/wjg.v25.i28.3753","journal-title":"World J Gastroenterol"},{"issue":"1","key":"10293_CR3","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1186\/s12876-020-1180-0","volume":"20","author":"F Liu","year":"2020","unstructured":"Liu F, Rong X, Guo H, et al. Clinical characteristics, CT signs, and pathological findings of Pyrrolizidine alkaloids-induced sinusoidal obstructive syndrome: a retrospective study. BMC Gastroenterol 2020;20(1):30. https:\/\/doi.org\/10.1186\/s12876-020-1180-0(Published 2020 Feb 4)","journal-title":"BMC Gastroenterol"},{"issue":"10","key":"10293_CR4","doi-asserted-by":"publisher","first-page":"1867","DOI":"10.1111\/liv.13684","volume":"38","author":"YZ Zhuge","year":"2018","unstructured":"Zhuge YZ, Wang Y, Zhang F, et al. Clinical characteristics and treatment of pyrrolizidine alkaloid-related hepatic vein occlusive disease. Liver Int 2018;38(10):1867\u20131874. https:\/\/doi.org\/10.1111\/liv.13684","journal-title":"Liver Int"},{"issue":"4","key":"10293_CR5","doi-asserted-by":"publisher","first-page":"634","DOI":"10.1111\/jgh.14612","volume":"34","author":"Y Zhuge","year":"2019","unstructured":"Zhuge Y, Liu Y, Xie W, et al. Expert consensus on the clinical management of pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome. J Gastroenterol Hepatol 2019;34(4):634\u2013642. https:\/\/doi.org\/10.1111\/jgh.14612","journal-title":"J Gastroenterol Hepatol"},{"issue":"1","key":"10293_CR6","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1186\/s12876-018-0879-7","volume":"18","author":"Y Wang","year":"2018","unstructured":"Wang Y, Qiao D, Li Y, Xu F. Risk factors for hepatic veno-occlusive disease caused by Gynura segetum: a retrospective study. BMC Gastroenterol 2018;18(1):156. https:\/\/doi.org\/10.1186\/s12876-018-0879-7(Published 2018 Oct 26)","journal-title":"BMC Gastroenterol"},{"issue":"11","key":"10293_CR7","first-page":"985","volume":"23","author":"XF Dong","year":"2018","unstructured":"Dong XF, Wang QC, Zhu XH, et al. Application and clinical analysis of anticoagulant and thrombolytic therapy in hepatic venular occlusive disease caused by Tu sanqi. Chin Hepatol 2018;23(11):985\u2013987 (in Chinese)","journal-title":"Chin Hepatol"},{"issue":"7","key":"10293_CR8","doi-asserted-by":"publisher","first-page":"906","DOI":"10.1038\/bmt.2016.130","volume":"51","author":"M Mohty","year":"2016","unstructured":"Mohty M, Malard F, Abecassis M, et al. Revised diagnosis and severity criteria for sinusoidal obstruction syndrome\/veno-occlusive disease in adult patients: a new classification from the European Society for blood and marrow transplantation. Bone Marrow Transplant 2016;51(7):906\u2013912. https:\/\/doi.org\/10.1038\/bmt.2016.130","journal-title":"Bone Marrow Transplant"},{"issue":"9","key":"10293_CR9","doi-asserted-by":"publisher","first-page":"1168","DOI":"10.1097\/MEG.0000000000001630","volume":"32","author":"C Peng","year":"2020","unstructured":"Peng C, Zhang X, Zhang F, et al. Clinical efficacy and safety of anticoagulation therapy for Pyrrolizidine alkaloids-induced hepatic sinusoidal obstruction syndrome: a retrospective multicenter cohort study. Eur J Gastroenterol Hepatol 2020;32(9):1168\u20131178. https:\/\/doi.org\/10.1097\/MEG.0000000000001630","journal-title":"Eur J Gastroenterol Hepatol"},{"issue":"12","key":"10293_CR10","first-page":"759","volume":"100","author":"A Smith","year":"2019","unstructured":"Smith A, Baumgartner K, Bositis C. Cirrhosis: diagnosis and management. Am Fam Physician 2019;100(12):759\u2013770","journal-title":"Am Fam Physician"},{"issue":"1","key":"10293_CR11","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1097\/00000542-200607000-00030","volume":"105","author":"American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies","year":"2006","unstructured":"American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Practice guidelines for perioperative blood transfusion and adjuvant therapies: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Anesthesiology 2006;105(1):198\u2013208. https:\/\/doi.org\/10.1097\/00000542-200607000-00030","journal-title":"Anesthesiology"},{"issue":"6","key":"10293_CR12","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1097\/EJA.0000000000000630","volume":"34","author":"SA Kozek-Langenecker","year":"2017","unstructured":"Kozek-Langenecker SA, Ahmed AB, Afshari A, et al. Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology: first update 2016. Eur J Anaesthesiol 2017;34(6):332\u2013395. https:\/\/doi.org\/10.1097\/EJA.0000000000000630","journal-title":"Eur J Anaesthesiol"},{"key":"10293_CR13","doi-asserted-by":"publisher","DOI":"10.1007\/s12072-020-10126-x","author":"J Xiao","year":"2021","unstructured":"Xiao J, Tu J, Zhang H, et al. Risk factors of poor prognosis in patients with pyrrolidine alkaloid-induced hepatic sinusoidal obstruction syndrome after transjugular intrahepatic portosystemic shunt. Hepatol Int 2021. https:\/\/doi.org\/10.1007\/s12072-020-10126-x(published online ahead of print, 2021 Jan 28)","journal-title":"Hepatol Int"},{"issue":"1","key":"10293_CR14","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s12072-018-09923-2","volume":"13","author":"X Xu","year":"2019","unstructured":"Chinese Society of Hepatology, Chinese Medical Association, Xu X, Duan Z, et al. Chinese guidelines on the management of ascites and its related complications in cirrhosis. Hepatol Int 2019;13(1):1\u201321. https:\/\/doi.org\/10.1007\/s12072-018-09923-2","journal-title":"Hepatol Int"},{"issue":"3","key":"10293_CR15","doi-asserted-by":"publisher","first-page":"345","DOI":"10.14218\/JCTH.2020.00124","volume":"9","author":"W Zhang","year":"2021","unstructured":"Zhang W, Liu L, Zhang M, et al. Validation of the Nanjing criteria for diagnosing pyrrolizidine alkaloids-induced hepatic sinusoidal obstruction syndrome. J Clin Transl Hepatol 2021;9(3):345\u2013352. https:\/\/doi.org\/10.14218\/JCTH.2020.00124","journal-title":"J Clin Transl Hepatol"},{"issue":"5","key":"10293_CR16","doi-asserted-by":"publisher","first-page":"2597","DOI":"10.21873\/anticanres.12501","volume":"38","author":"S Nassereddine","year":"2018","unstructured":"Nassereddine S, Alsubait S, Tabbara I. Sinusoidal obstruction syndrome (veno-occlusive disease) following hematopoietic stem cell transplant: insights and therapeutic advances. Anticancer Res 2018;38(5):2597\u20132605. https:\/\/doi.org\/10.21873\/anticanres.12501","journal-title":"Anticancer Res"},{"key":"10293_CR17","doi-asserted-by":"publisher","first-page":"781","DOI":"10.1038\/bmt.2015.52","volume":"50","author":"M Mohty","year":"2015","unstructured":"Mohty M, Malard F, Abecassis M, et al. Sinusoidal obstruction syndrome\/veno-occlusive disease: current situation and perspectives-a position statement from the European Society for Blood and Marrow Transplantation (EBMT). Bone Marrow Transplant 2015;50:781\u2013789","journal-title":"Bone Marrow Transplant"},{"issue":"23","key":"10293_CR18","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000000942","volume":"94","author":"X Wang","year":"2015","unstructured":"Wang X, Qi X, Guo X. Tusanqi-related sinusoidal obstruction syndrome in china: a systematic review of the literatures. Medicine (Baltimore) 2015;94(23): e942. https:\/\/doi.org\/10.1097\/MD.0000000000000942","journal-title":"Medicine (Baltimore)"},{"issue":"26","key":"10293_CR19","doi-asserted-by":"publisher","first-page":"4023","DOI":"10.1182\/blood-2014-03-551630","volume":"123","author":"N Chao","year":"2014","unstructured":"Chao N. How I treat sinusoidal obstruction syndrome. Blood 2014;123(26):4023\u20134026. https:\/\/doi.org\/10.1182\/blood-2014-03-551630","journal-title":"Blood"},{"key":"10293_CR20","first-page":"251","volume":"39","author":"CL Hou","year":"2019","unstructured":"Hou CL, Xu J, Qin HL, et al. Efficacy of transjugular intrahepatic portosystemic shunt in the treatment of 21 patients with Gynura segetum-related hepatic sinusoidal obstruction syndrome. Chin J Dig 2019;39:251\u2013256 (in Chinese)","journal-title":"Chin J Dig"},{"issue":"01","key":"10293_CR21","first-page":"46","volume":"29","author":"YR Chen","year":"2021","unstructured":"Chen YR, Zhang W, Zhang M, et al. Prognostic value of the PA-HSOS criteria for severity grading in PA-HSOS patients treated with TIPS. Chin J Heptol 2021;29(01):46\u201353 ((in Chinese))","journal-title":"Chin J Heptol"},{"key":"10293_CR22","doi-asserted-by":"publisher","first-page":"4861","DOI":"10.2147\/DDDT.S87858","volume":"9","author":"H Gao","year":"2015","unstructured":"Gao H, Ruan JQ, Chen J, et al. Blood pyrrole-protein adducts as a diagnostic and prognostic index in pyrrolizidine alkaloid-hepatic sinusoidal obstruction syndrome. Drug Des Dev Ther 2015;9:4861\u20134868. https:\/\/doi.org\/10.2147\/DDDT.S87858 (Published 2015 Aug 25)","journal-title":"Drug Des Dev Ther"},{"issue":"2","key":"10293_CR23","doi-asserted-by":"publisher","first-page":"759","DOI":"10.1007\/s00204-020-02947-4","volume":"95","author":"J Ma","year":"2021","unstructured":"Ma J, Zhang W, He Y, et al. Clinical application of pyrrole-hemoglobin adducts as a biomarker of pyrrolizidine alkaloid exposure in humans. Arch Toxicol 2021;95(2):759\u2013765. https:\/\/doi.org\/10.1007\/s00204-020-02947-4","journal-title":"Arch Toxicol"}],"container-title":["Hepatology International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12072-021-10293-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s12072-021-10293-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12072-021-10293-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,6,8]],"date-time":"2022-06-08T01:06:20Z","timestamp":1654650380000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s12072-021-10293-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,12]]},"references-count":23,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2022,6]]}},"alternative-id":["10293"],"URL":"https:\/\/doi.org\/10.1007\/s12072-021-10293-5","relation":{},"ISSN":["1936-0533","1936-0541"],"issn-type":[{"value":"1936-0533","type":"print"},{"value":"1936-0541","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,12]]},"assertion":[{"value":"5 September 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 December 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 January 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Xuan Wang, Wei Zhang, Ming Zhang, Feng Zhang, Jiangqiang Xiao, Qin Yin, Hao Han, Taishun Li, Ge Lin and Yuzheng Zhuge  declared that there are no potential conflicts of interest in this study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"this study was registered (ChiCTR2100050417) and approved by the ethic committees of Nanjing Drum Tower Hospital and conformed to the principles of the World Medical Association Declaration of Helsinki, as revised in 2013.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"this study was a retrospective study, so the authors requested and received permission to waive informed consent.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}