4种评分系统对肝硬化合并感染患者预后的评估价值

姚运海; 甘建和; 赵卫峰

doi:10.3969/j.issn.1001-5256.2019.01.016

4种评分系统对肝硬化合并感染患者预后的评估价值

DOI: 10.3969/j.issn.1001-5256.2019.01.016

苏州大学附属第一医院感染科/肝病ICU

基金项目:

医学科学研究基金(YWJKJJHKYJJ-G17016)；

详细信息

中图分类号: R575.2
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出版历程
- 收稿日期: 2018-08-31
- 出版日期: 2019-01-20

Value of four scoring systems in evaluating the prognosis of cirrhotic patients with infection

Department of Infectious Diseases/Intensive Care Unit of Hepatology, The First Hospital Affiliated to Soochow University

Research funding:

摘要

摘要: 目的探讨Child-Turcotte-Pugh评分（CTP）、终末期肝病模型（MELD）评分、慢性肝衰竭-器官衰竭评分（CLIF-SOFA）以及亚太肝病学会慢加急性肝衰竭研究工作组评分（AARC）评价终末期肝病（ESLD）合并感染的预后价值。方法回顾性分析2014年1月-2017年12月苏州大学附属第一医院收治的肝硬化合并感染患者的临床资料,根据住院期间预后情况将患者分为内科综合治疗病情稳定者（A组）和住院期间治疗无效死亡、自动出院放弃治疗、内科治疗无效行肝移植者（B组）。比较2组患者一般资料,住院期间临床指标最差值,CTP评分、MELD评分、CLIF-SOFA评分、AARC评分、器官替代治疗（包括机械通气、人工肝支持系统、肾脏替代治疗等）。计量资料2组间比较采用t检验或Mann-Whitney U检验;计数资料2组间比较采用χ2检验。将单因素分析中差异有统计学意义的变量进行logistic回归分析;利用受试者工作特征曲线（ROC）分析4种评分系统预测患者预后效能。结果最终纳入522例肝硬化合并感染患者,存活381例,死亡141例,病死率为27. 01%。单因素分析显示PLT、TBil...
- 肝硬化 /
- 感染 /
- 终末期肝病 /
- 预后
Abstract: Objective To investigate the value of Child-Turcotte-Pugh (CTP) score, Model for End-Stage Liver Disease (MELD) score, chronic liver failure-sequential organ failure assessment (CLIF-SOFA) score, and APASL-ACLF Research Consortium (AARC) score in evaluating the prognosis of cirrhotic patients with infection.Methods A retrospective analysis was performed for the clinical data of cirrhotic patients with infection who were admitted to The First Hospital Affiliated to Soochow University from January 2014 to December2017, and according to their prognosis during hospitalization, they were divided into group A (patients with a stable disease after comprehensive internal medicine treatment) and group B (patients who died during hospitalization, who left the hospital and gave up treatment, or who underwent liver transplantation due to no response to internal medicine treatment) .The two groups were compared in terms of general information, the worst values of clinic indices during hospitalization, CTP score, MELD score, CLIF-SOFA score, AARC score, and organ replacement therapy (including mechanical ventilation, artificial liver support system, and renal replacement therapy) .The t-test or the Mann-Whitney U test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups.A logistic regression analysis was performed for the variables with statistical significance in the univariate analysis, and the receiver operating characteristic (ROC) curve was used to assess the efficiency of these four scoring systems in predicting prognosis.Results A total of 522 cirrhotic patients with infection were enrolled, among whom 381 survived and 141 died, resulting in a mortality rate of 27.01%.The univariate analysis showed that there were significant differences between the two groups in platelet count, total bilirubin, arterial blood lactate, international normalized ratio, CTP score, MELD score, CLIF-SOFA score, and AARC score (all P<0.05) , and the multivariate logistic regression analysis showed that all these four scoring systems had a strong predictive value and CTP score (odds ratio[OR]=2.308, 95%confidence interval[CI]:0.640-0.796, P=0.016) , MELD score (OR=0.632, 95%CI:0.638-0.814, P=0.007) , CLIF-SOFA score (OR=1.920, 95%CI:0.788-0.908, P=0.017) , and AARC score (OR=0.713, 95%CI:0.751-0.882, P=0.005) were independent factors for the prognosis of cirrhotic patients with infection.The ROC curve analysis showed that all these four scoring systems could predict the prognosis of cirrhotic patients with infection, and the CLIF-SOFA score had the strongest predictive efficiency, with a sensitivity of 0.854, a specificity of 0.690, and an area under the ROC curve of 0.848.Conclusion CTP score, MELD score, CLIF-SOFA score, and AARC score can predict the prognosis of cirrhotic patients with infection and provide guidance to anti-infective therapy.Among them, CLIF-SOFA score has a high predictive value and can be widely used in clinical practice.
- liver cirrhosis /
- infection /
- end stage of liver disease /
- prognosis

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参考文献(24)

[1]BRUDEN DJT, McMAHON BJ, TOWNSHEND-BULSON L, et al.Risk of end-stage liver disease, hepatocellular carcinoma, and liver-related death by fibrosis stage in the hepatitis C Alaska Cohort[J].Hepatology, 2017, 66 (1) :37-45.

[2]de MATTOSZ, de MATTOS AA.Model for end-stage liver disease-based allocation system:On the right path, but not there yet[J].Hepatology, 2016, 63 (1) :344.

[3]Society of Infectious Diseases, Chinese Medical Association.Expert consensus on diagnosis and treatment of end-stage liver disease complicated infection[J].J Clin Hepatol, 2018, 34 (9) :1862-1872. (in Chinese) 中华医学会感染病学分会.终末期肝病合并感染诊治专家共识[J].临床肝胆病杂志, 2018, 34 (9) :1862-1872.

[4]European Association for the Study of the Liver.EASL clinical practice guidelines for the management of patients with decompensated cirrhosis[J].J Hepatol, 2018, 69 (2) :406-460.

[5]MARRERO JA, KULIK LM, SIRLIN CB, et al.Diagnosis, staging, and management of hepatocellular carcinoma:2018 practice guidance by the american association for the study of liver diseases[J].Hepatology, 2018, 68 (2) :723-750.

[6]CAI J, ITO M, NAGATA H, et al.Treatment of liver failure in rats with end-stage cirrhosis by transplantation of immortalized hepatocytes[J].Hepatology, 2002, 36 (2) :386-394.

[7]BERNARDI M, MOREAU R, ANGELI P, et al.Mechanisms of decompensation and organ failure in cirrhosis:From peripheral arterial vasodilation to systemic inflammation hypothesis[J].JHepatol, 2015, 63 (5) :1272-1284.

[8]ACHARYA C, BAJAJ JS.The microbiome in cirrhosis and its complications[J].Clin Gastroenterol Hepatol, 2018.[Epub ahead of print]

[9]SHIZUMA TS.Pontaneous bacterial and fungal peritonitis in patients with liver cirrhosis:A literature review[J].World JHepatol, 2018, 10 (2) :254-266.

[10]Chinese Society of Hepatology, Chinese Medical Association.Guidelines on the management of ascites and complications in cirrhosis[J].J Clin Hepatol, 2017, 33 (10) :1847-1863. (in Chinese) 中华医学会肝病学分会.肝硬化腹水及相关并发症的诊疗指南[J].临床肝胆病杂志, 2017, 33 (10) :1847-1863.

[11]LAN P, WANG SJ, SHI QC, et al.Comparison of the predictive value of scoring systems on the prognosis of cirrhotic patients with suspected infection[J].Medicine, 2018, 97 (28) :e11421.

[12]KULKARNI S, SHARMA M, RAO PN, et al.Acute on chronic liver failure-in-hospital predictors of mortality in ICU[J].JClin Exp Hepatol, 2018, 8 (2) :144-155.

[13]WU D, SUN Z, LIU X, et al.HINT:A novel prognostic model for patients with hepatitis B virus-related acute-on-chronic liver failure[J].Aliment Pharmacol Ther, 2018, 48 (7) :750-760.

[14]LUO X, MASSIE AB, GENTRY SE, et al.MELD allocation system:There is always space to improve[J].Am J Transplant, 2018, 18 (11) :2834-2835.

[15] SELVA RAJOO A, LIM SG, PHYO, et al.Acute-on-chronic liver failure in a multi-ethnic Asian city:A comparison of patients identified by Asia-Pacific Association for the Study of the Liver and European Association for the Study of the Liver definitions[J].World J Hepatol, 2017, 9 (28) :1133-1140.

[16]BANSHO ETO, SILVA PES, COLOMBO BS, et al.Prognostic significance of the new criteria for acute kidney injury in cirrhosis[J].Ann Hepatol, 2018, 17 (3) :461-469.

[17] ZHOU XD, CHEN QF, ZHANG MC, et al.Scoring model to predict outcome in critically ill cirrhotic patients with acute respiratory failure:Comparison with MELD scoring models and CLIF-SOFA score[J].Expert Rev Gastroenterol Hepatol, 2017, 11 (9) :857-864.

[18]KANASHVILI B, SAGANELIDZE K, RATIANI L.The role of procalcitonin and blood lactic acid values in prognosis of sepsis and septic shock in polytrauma patients[J].Georgian Med News, 2018, N6 (279) :102-107.

[19]CHOUDHURY A, JINDAL A, MAIWALL R, et al.Liver failure determines the outcome in patients of acute-on-chronic liver failure (ACLF) :Comparison of APASL ACLF research consortium (AARC) and CLIF-SOFA models[J].Hepatol Int, 2017, 11 (5) :461-471.

[20]ZHANG L, CHEN W, SHENG YJ, et al.Value of Model for EndStage Liver Disease score combined with neutrophil-lymphocyte ratio in predicting the short-term prognosis of patients with HBV-related acute-on-chronic liver failure[J].J Clin Hepatol, 2018, 34 (3) :553-557. (in Chinese) 张丽, 陈文, 盛云健, 等.MELD评分联合中性粒细胞/淋巴细胞比值对HBV相关慢加急性肝衰竭短期预后的预测价值[J].临床肝胆病杂志, 2018, 34 (3) :553-557.

[21]SELVA-RAJOO A, LIM SG, PHYO WW, et al.Acute-onchronic liver failure in a multi-ethnic Asian city:A comparison of patients identified by Asia-Pacific Association for the Study of the Liver and European Association for the Study of the Liver definitions[J].World J Hepatol, 2017, 9 (28) :1133-1140.

[22]ZHANG X, CHEN P, GAO H, et al.Bacterial infection and predictors of mortality in patients with autoimmune liver disease-associated acute-on-chronic liver failure[J].Can JGastroenterol Hepatol, 2018, 2018:5108781.

[23]ZHOU XD, CHEN QF, ZHANG MC, et al.Scoring model to predict outcome in critically ill cirrhotic patients with acute respiratory failure:Comparison with MELD scoring models and CLIF-SOFA score[J].Expert Rev Gastroenterol Hepatol, 2017, 11 (9) :857-864.

[24]BAO T, TAO B, GAO YF.Research Progress of antiviral efficacy in patients with chronic hepatitis B on predictors[J].JClin Hepatol, 2017, 33 (10) :1997-2000. (in Chinese) 鲍腾, 陶奔, 郜玉峰.慢性乙型肝炎患者抗病毒疗效预测指标的研究进展[J].临床肝胆病杂志, 2017, 33 (10) :1997-2000.

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