Cao D, Li D J, Wang Y, Zhang Y H, Chen L Y, Wang L C
Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu 610041, China.
Zhonghua Gan Zang Bing Za Zhi. 2019 Feb 20;27(2):118-122. doi: 10.3760/cma.j.issn.1007-3418.2019.02.009.
To investigate the risk factors affecting the short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF), and establish a new scoring model to predict the short-term prognosis of patients. This study enrolled 222 patients with HBV-ACLF. According to their clinical outcomes during hospitalization and 90 days after discharge, they were divided into survival and death group. Clinical data were collected to calculate the Child-Turcotte-Pugh (CTP), model for end-stage liver disease (MELD), albumin-bilirubin (ALBI), and age-bilirubin-international normalized ratio-creatinine (ABIC) scores for prognosis. Multivariate logistic regression analysis was used to analyze the independent risk factors affecting 90-day mortality in HBV-ACLF patients. Cox regression model was used to establish a new prediction model. Area under the receiver operating characteristic curve was used to calculate short-term prognostic value of the models. K-M survival curve was used to predict the prognosis of patients. CTP and ABIC scores were independent risk factors for 90-day mortality in HBV-ACLF patients, and the risk of death from liver failure had increased with increase of score. Cox regression model established a new predictive model CTP-ABIC = 0.551 × CTP + 0.297 × ABIC. Area under the receiver operating characteristic curve of all three scoring models (CTP, ABIC and CTP-ABIC) were 0.878, 0.829, 0.927, respectively. CTP-ABIC score was superior to the CTP and ABIC score ( value < 0.001). Patients with CTP-ABIC score ≥9.08 had higher mortality rate than patients with CTP-ABIC score < 9.08, and the difference was statistically significant ( < 0.001). All three scoring systems can predict short-term prognosis in patients with HBV-ACLF, but the accuracy of CTP-ABIC is superior.
探讨影响乙型肝炎病毒相关性慢加急性肝衰竭(HBV-ACLF)患者短期预后的危险因素,并建立一种新的评分模型以预测患者的短期预后。本研究纳入了222例HBV-ACLF患者。根据其住院期间及出院后90天的临床结局,将他们分为生存组和死亡组。收集临床数据以计算用于预后评估的Child-Turcotte-Pugh(CTP)、终末期肝病模型(MELD)、白蛋白-胆红素(ALBI)以及年龄-胆红素-国际标准化比值-肌酐(ABIC)评分。采用多因素logistic回归分析来分析影响HBV-ACLF患者90天死亡率的独立危险因素。使用Cox回归模型建立新的预测模型。采用受试者工作特征曲线下面积来计算各模型的短期预后价值。使用K-M生存曲线来预测患者的预后。CTP和ABIC评分是HBV-ACLF患者90天死亡率的独立危险因素,且肝衰竭死亡风险随评分升高而增加。Cox回归模型建立了新的预测模型CTP-ABIC = 0.551×CTP + 0.297×ABIC。三种评分模型(CTP、ABIC和CTP-ABIC)的受试者工作特征曲线下面积分别为0.878、0.829、0.927。CTP-ABIC评分优于CTP和ABIC评分(P值<0.001)。CTP-ABIC评分≥9.08的患者死亡率高于CTP-ABIC评分<9.08的患者,差异具有统计学意义(P<0.001)。三种评分系统均能预测HBV-ACLF患者的短期预后,但CTP-ABIC的准确性更高。