肝硬化合并细菌性腹水患者30天内死亡预测模型的建立

黄云义; 王宪波

doi:10.3969/j.issn.1001-5256.2019.11.017

肝硬化合并细菌性腹水患者30天内死亡预测模型的建立

DOI: 10.3969/j.issn.1001-5256.2019.11.017

1. 北京中医药大学东直门医院
2. 首都医科大学附属北京地坛医院中西医结合中心

基金项目:

首都卫生发展科研专项批准项目(2018-1-2172)；北京市医院管理局临床医学发展专项经费资助(ZYLX201707)；

详细信息

中图分类号: R575.2
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出版历程
- 收稿日期: 2019-07-02
- 出版日期: 2019-11-20

Establishment of a predictive model of death within 30 days for patients with liver cirrhosis and bacterial ascites

Dongzhimen Hospital,Beijing University of Chinese Medicine

Research funding:

摘要

摘要: 目的探讨肝硬化合并细菌性腹水患者30 d内死亡的危险因素,并建立可以预测其30 d内死亡的预测模型。方法回顾性收集2012年1月-2018年4月首都医科大学附属北京地坛医院收治的肝硬化合并细菌性腹水患者86例,对其进行为期30 d的随访观察,根据患者预后将其分为生存组（n=73例）与死亡组（n=13例）。符合正态分布的计量资料组间比较采用t检验,非正态分布的计量资料组间比较采用Mann-Whitney U检验,计数资料组间比较采用χ2检验。采用logistic回归分析探讨肝硬化合并细菌性腹水患者30 d内死亡的影响因素,并根据影响因素建立预测模型。用受试者工作特征曲线下面积（AUC）评估各独立影响因素和预测模型的预测价值。结果 logistic多因素回归分析发现腹水白蛋白[比值比（OR）=0. 615,95%可信区间（95%CI）:0. 424～0. 893,P=0. 011]、中性粒细胞与淋巴细胞比值（NLR）（OR=1. 170,95%CI:1. 011～1. 354,P=0. 035）、MELD评分（OR=1. 341,95%CI:1. 111～1. 618...
- 肝硬化 /
- 细菌性腹水 /
- 腹膜炎 /
- 预后 /
- Logistic模型
Abstract: Objective To investigate the risk factors for death within 30 days in patients with liver cirrhosis and bacterial ascites,and to establish a predictive model of death within 30 days. Methods A retrospective analysis was performed for the clinical data of 86 patients with liver cirrhosis and bacterial ascites who were admitted to Beijing Ditan Hospital,Capital Medical University,from January 2012 to April 2018.The patients were followed up for 30 days,and according to their prognosis,they were divided into survival group with 73 patients and death group with 13 patients. The t-test was used for comparison of normally distributed continuous data between groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups. A logistic regression analysis was used to investigate the influencing factors for death within 30 days in patients with liver cirrhosis and bacterial ascites,and a predictive model was established based on these influencing factors. The area under the receiver operating characteristic curve was used to evaluate the predictive value of each independent influencing factor and the predictive model. Results The multivariate logistic regression analysis showed that there were significant differences between the survival group and the death group in ascites albumin( odds ratio [OR]= 0. 615,95% confidence interval [CI]: 0. 424-0. 893,P = 0. 011),neutrophil-to-lymphocyte ratio( NLR)( OR =1. 170,95% CI: 1. 011-1. 354,P = 0. 035),and Model for End-Stage Liver Disease( MELD) score( OR = 1. 341,95%CI: 1. 111-1. 618,P = 0. 002). A scoring model was established based on the results of the multivariate analysis to predict death within 30 days in patients with liver cirrhosis and bacterial ascites,and based on this model,the patients were divided into high-risk group with death within 30 days( score ≥2 points) and low-risk group with death within 30 days( score < 2 points). There was a significant difference in mortality rate with 30 days between the two groups( 60. 0% vs 5. 6%,P < 0. 001). Conclusion Ascites albumin ≤3. 5 g/L,NLR ≥6. 5,and MELD score ≥20 are independent risk factors for death within 30 days in patients with liver cirrhosis and bacterial ascites. The predictive model established on this basis can effectively evaluate the population at high risk of death within 30 days.
- liver cirrhosis /
- bacterial ascites /
- peritonitis /
- prognosis /
- logistic models

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参考文献(21)

[1] European Association for the Study of the Liver. EASL clinical practice guidelines on the management of ascites,spontaneous bacterial peritonitis,and hepatorenal syndrome in cirrhosis[J]. J Hepatol,2010,53(3):397-417.

[2] TANDON P,KUMAR D,SEO YS,et al. The 22/11 risk prediction model:A validated model for predicting 30-day mortality in patients with cirrhosis and spontaneous bacterial peritonitis[J]. Am J Gastroenterol,2013,108(9):1473-1479.

[3] ANGELONI S,LEBOFFE C,PARENTE A,et al. Efficacy of current guidelines for the treatment of spontaneous bacterial peritonitis in the clinical practice[J]. World J Gastroenterol,2008,14(17):2757-2762.

[4] RUNYON BA,AASLD Practice Guidelines Committee. Management of adult patients with ascites due to cirrhosis:An update[J]. Hepatology,2009,49(6):2087-2107.

[5] 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.

[6] CHEN HZ. Practical internal medicine[M]. Beijing:People’s Medical Publishing House,2001:1850.(in Chinese)陈灏珠．实用内科学[M]．北京:人民卫生出版社，2001:1850.

[7] ILIAZ R,OZPOLAT T,BARAN B,et al. Predicting mortality in patients with spontaneous bacterial peritonitis using routine inflammatory and biochemical markers[J]. Eur J Gastroenterol Hepatol,2018,30(7):786-791.

[8] OLIVEIRA AM,BRANCO JC,BAROSA R,et al. Clinical and microbiological characteristics associated with mortality in spontaneous bacterial peritonitis:A multicenter cohort study[J]. Eur J Gastroenterol Hepatol,2016,28(10):1216-1222.

[9] HEO J,SEO YS,YIM HJ,et al. Clinical features and prognosis of spontaneous bacterial peritonitis in Korean patients with liver cirrhosis:A multicenter retrospective study[J]. Gut Liver,2009,3(3):197-204.

[10] NOBRE SR,CABRAL JE,GOMES JJ,et al. In-hospital mortality in spontaneous bacterial peritonitis:A new predictive model[J]. Eur J Gastroenterol Hepatol,2008,20(12):1176-1181.

[11] XIONG Q,ZHOU YF,YANG GW. Changes and significance of serum and ascites CA125 and albumin levels in patients with cirrhosis and spontaneous bacterial peritonitis[J]. Shandong Med J,2016,56(13):43-44.(in Chinese)熊琴，周英发，杨国威．肝硬化并自发性细菌性腹膜炎患者血清和腹水中CA125、白蛋白水平变化及意义[J]．山东医药，2016,56(13):43-44.

[12] FERNANDEZ J,NAVASA M,GARCIA-PAGAN JC,et al.Effect of intravenous albumin on systemic and hepatic hemodynamics and vasoactive neurohormonal systems in patients with cirrhosis and spontaneous bacterial peritonitis[J]. J Hepatol,2004,41(3):384-390.

[13] FAN Y,LI X,ZHOU XF,et al. Value of neutrophil-lymphocyte ratio in predicting hepatitis B-related liver failure[J]. Chin J Hepatol,2017,25(10):726-731.(in Chinese)范玥，李欣，周晓芳，等．中性粒细胞淋巴细胞比值在预测乙型肝炎相关肝衰竭中的作用[J]．中华肝脏病杂志，2017,25(10):726-731.

[14] FERNANDEZ-RUIZ M,LOPEZ-MEDRANO F,ROMO EM,et al. Pretransplant lymphocyte count predicts the incidence of infection during the first two years after liver transplantation[J].Liver Transpl,2009,15(10):1209-1216.

[15] GUARNER C,SORIANO G. Bacterial translocation and its consequences in patients with cirrhosis[J]. Eur J Gastroenterol Hepatol,2005,17(1):27-31.

[16] LI LJ,WU ZW. Study on the role of intestinal microecological changes in chronic liver diseases[J]. Chin J Microecol,2002,14(2):2-3.(in Chinese)李兰娟，吴仲文．重视肠道微生态变化在慢性肝病中作用的研究[J]．中国微生态学杂志，2002,14(2):2-3.

[17] GUO YN,XU YQ,WANG L. Study on the relationship between procalcitonin in ascites,cytokines and intestinal mucosal barrier function in patients with cirrhosis and spontaneous peritonitis[J]. J Clin Exp Med,2019,18(14):1528-1531.(in Chinese)郭玉宁，徐有青，王麟．肝硬化合并自发性细菌性腹膜炎患者腹水降钙素原与细胞因子和肠黏膜屏障功能的相关性研究[J]．临床和实验医学杂志，2019,18(14):1528-1531.

[18] LIU JQ. Understanding the structural shifts of gut microbiota in patients with chronic viral hepatitis B[D]. Shanghai:Shanghai Jiao Tong University,2011.(in Chinese)刘嘉颀．慢性乙型肝炎患者肠道菌群结构的分子生态学研究[D]．上海:上海交通大学，2011.

[19] TONG XB. Clinical analysis of 90 cases of cirrhotic ascites with spontaneous bacterial peritonitis[J]. Int Med China,2015,10(5):672-673.(in Chinese)童锡宝．肝硬化腹水伴自发性细菌性腹膜炎90例临床分析[J]．内科，2015,10(5):672-673.

[20] YI AF. Essentials of hepatitis B cirrhosis complicated with spontaneous bacterial peritonitis[J]. J Qiqihar Med Coll,2014,35(6):844-845.(in Chinese)易爱芬．乙肝肝硬化并发自发性细菌性腹膜炎关键要点探索[J]．齐齐哈尔医学院学报，2014,35(6):844-845.

[21] WEI CJ,LI DH,WANG CM. Corynebacterium urealyticum-an important pathogen of clinical opportunistic infections[J]. Int J Lab Med,2017,38(1):89-91.(in Chinese)魏超君，李德红，王超美．解脲棒杆菌———重要的临床机会性感染病原菌[J]．国际检验医学杂志，2017,38(1):89-91.

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