HBV相关慢加急性肝衰竭患者短期预后预测模型的建立与评价

胡辉; 黄贝贝; 宁玲; 江守伟; 沈强; 刘磊; 李磊

doi:10.3969/j.issn.1001-5256.2020.01.027

HBV相关慢加急性肝衰竭患者短期预后预测模型的建立与评价

DOI: 10.3969/j.issn.1001-5256.2020.01.027

安徽医科大学附属省立医院感染病科

基金项目:

安徽省自然科学基金青年基金(1208085QH147)；

详细信息

中图分类号: R575.3;R512.62
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- 被引次数: 15
出版历程
- 收稿日期: 2019-08-21
- 出版日期: 2020-01-20

Establishment and evaluation of a predictive model for short-time prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure

Department of Infectious Diseases,The Affiliated Provincial Hospital of Anhui Medical University

Research funding:

摘要

摘要: 目的探讨HBV相关慢加急性肝衰竭（HBV-ACLF）患者短期（12周）生存预后的预测因素,建立新型预测模型。方法收集2015年4月-2018年8月在安徽医科大学附属省立医院确诊HBV-ACLF的67例患者的临床资料,根据确诊后12周随访生存情况分为生存组（n=28）和死亡组（n=39）。收集患者临床资料,包括性别、年龄、TBil、国际标准化比值（INR）、肌酐（Cr）、血清钠、PLT、ALT、AST、Alb、血清胱抑素C（CysC）,是否有急性肾损伤（AKI）。正态分布的计量资料2组间比较采用t检验,偏态分布的计量资料2组间比较采用Wilcoxon秩和检验;计数资料组间比较采用χ2检验;影响HBV-ACLF患者预后因素采用多因素logistic回归法并建立预测模型;采用受试者工作特征曲线（ROC曲线）评价预测模型,ROC曲线下面积（AUC）的比较采用DeLong法。结果死亡组患者的年龄、TBil、INR、CysC、MELD评分均高于生存组,合并AKI患者的近期生存率明显低于无AKI者（P值均<0. 05）。TBil[比值比（OR）=1. 013,95%可信区间（95%CI）:1....
- 慢加急性肝功能衰竭 /
- 乙型肝炎病毒 /
- 急性肾损伤 /
- 预后
Abstract: Objective To investigate the predictive factors for short-term(12-week) survival and prognosis of patients with hepatitis B virus(HBV)-related acute-on-chronic liver failure(HBV-ACLF),and to establish a new predictive model. Methods Related clinical data were collected from 67 patients who were diagnosed with HBV-ACLF in The Affiliated Provincial Hospital of Anhui Medical University from April 2015 to August 2018,and according to their survival at 12-week follow-up after diagnosis,they were divided into survival group with 28 patients and death group with 39 patients. Their clinical data were collected,including sex,age,total bilirubin(TBil),international normalized ratio(INR),creatinine(Cr),serum sodium,platelet count(PLT),alanine aminotransferase(ALT),aspartate aminotransferase(AST),albumin(Alb),serum cystatin C(CysC),and presence or absence of acute kidney injury(AKI). The t-test was used for comparison of normally distributed continuous data between two groups,and the Wilcoxon rank-sum test was used for comparison of continuous data with skewed distribution between two groups; the chi-square test was used for comparison of categorical data between groups; logistic regression was used to perform the factorial analysis and establish a predictive model; the receiver operator characteristic(ROC) curve was used to evaluate the predictive model,and the method by DeLong et al. was used to compare the area under the ROC curve(AUC). Results The death group had significantly higher age,TBil,INR,CysC,and Model for End-Stage Liver Disease(MELD) score than the survival group,and the patients with AKI had a significantly lower short-term survival rate than those without AKI(all P < 0. 05). TBil(odds ratio [OR]= 1. 013,95% confidence interval [CI]: 1. 003-1. 024,P = 0. 014),INR(OR = 6. 857,95%CI: 1. 449-32. 449,P = 0. 015),CysC(OR = 2. 826,95% CI: 1. 001-7. 983,P = 0. 050),and PLT(OR = 0. 982,95% CI: 0. 964-1. 000,P = 0. 048) were independent predictive factors for patient survival. A TICP model was established with the combination of TBil,INR,CysC,and PLT,and there was a significant difference in AUC between the TICP model and MELD score[0. 879(95% CI: 0. 776-0. 946) vs 0. 760(95% CI: 0. 644-0. 859),Z = 2. 708,P = 0. 007]. Compared with MELD score,the TICP model had significantly better accuracy(87. 05% vs 67. 16%),sensitivity(84. 62% vs 56. 41%),and Youden index(0. 70 vs 0. 42). Conclusion TBil,INR,CysC,and PLT are independent influencing factors for short-term prognosis of HBV-ACLF patients,and the TICP predictive model with the combination of these four indices has a good value in predicting the short-term survival and prognosis of HBV-ACLF patients.
- acute-on-chronic liver failure /
- hepatitis B virus /
- acute kidney injury /
- prognosis

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参考文献(30)

[1] Liver Failure and Artificial Liver Group,Chinese Society of Infectious Diseases,CMA; Severe Liver Disease and Artificial Liver Group,Chinese Society of Hepatology,CMA. Guideline for diagnosis and treatment of liver failure[J]. J Clin Hepatol,2019,35(1):38-44.(in Chinese)中华医学会感染病学分会肝衰竭与人工肝学组，中华医学会肝病学分会重型肝病与人工肝学组．肝衰竭诊治指南(2018年版)[J]．临床肝胆病杂志，2019,35(1):38-44.

[2] ZHOU ZJ,LI JQ,BIN YY,et al. Effect of donor risk index on early prognosis of liver transplantation for acute-on-chronic liver failure:Experience of 159 cases in one single center[J].Ogran Transplantation,2019,10(3):318-322.(in Chinese)周政俊，李杰群，宾阳阳，等．供体风险指数对慢加急性肝衰竭肝移植治疗早期预后的影响:单中心159例经验[J]．器官移植，2019,10(3):318-322.

[3] Chinese Society of Hepatology and Chinese Society of Infectious Diseases,Chinese Medical Association. The guideline of prevention and treatment for chronic hepatitis B:A 2015 update[J]. J Clin Hepatol,2015,31(12):1941-1960.(in Chinese)中华医学会肝病学分会，中华医学会感染病学分会．慢性乙型肝炎防治指南(2015年更新版)[J]．临床肝胆病杂志，2015,31(12):1941-1960.

[4] ANGELI P,GINES P,WONG F,et al. Diagnosis and management of acute kidney injury in patients with cirrhosis:Revised consensus recommendations of the International Club of Ascites[J]. Gut,2015,64(4):531-537.

[5] KAMATH PS,KIM WR. The model for end-stage liver disease(MELD)[J]. Hepatology,2007,45(3):797-805.

[6] DING R,ZHAO H,YAN J,et al. Defination and treatment progress of acute-on-chronic liver failure[J/CD]. Chin J Liver Dis(Electronic Version),2018,10(1):1-5.(in Chinese)丁蕊，赵红，闫杰，等．慢加急性肝衰竭的定义及治疗进展[J/CD]．中国肝脏病杂志(电子版)，2018,10(1):1-5.

[7] WONG F,O’LEARY JG,REDDY KR,et al. New consensus definition of acute kidney injury accurately predicts 30-day mortality in patients with cirrhosis and infection[J]. Gastroenterology,2013,145(6):1280-1288.

[8] WU ZP,ZHONG YB,LI XP,et al. The analysis of acute kidney injury in hepatitis B virus related acute-on-chronic liver failure[J]. Chin J Infect Dis,2016,34(12):714-716.(in Chinese)吴振平，钟渊斌，李小鹏，等．乙型肝炎病毒相关慢加急性(亚急性)肝功能衰竭患者中急性肾损伤的分析[J]．中华传染病杂志，2016,34(12):714-716.

[9] SARIN SK,KUMAR A,ALMEIDA JA,et al. Acute-on-chronic liver failure:Consensus recommendations of the Asian Pacific Association for the study of the liver(APASL)[J]. Hepatol Int,2009,3(1):269-282.

[10] MOREAU R,JALAN R,GINES P,et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis[J]. Gastroenterology,2013,144(7):1426-1437.

[11] ZHANG LF,WANG JF. Anaysis of related factors of HBVACLF pateintsoccured AKI[J]. Chin Hepatol,2015,20(8):606-609.(in Chinese)张玲芳，王介非．乙型肝炎相关慢加急性肝衰竭患者发生急性肾损伤的相关因素分析[J]．肝脏，2015,20(8):606-609.

[12] TANG XJ,MEI CL. Interpretation of KDIGO guideline for diagnosis and treatment of acute kidney injury[J]. Chin J Pract Intern Med,2012,32(12):914-917.(in Chinese)汤晓静，梅长林．KDIGO指南解读:急性肾损伤的诊治[J]．中国实用内科杂志，2012,32(12):914-917.

[13] KARVELLAS CJ,DURAND F,NADIM MK. Acute kidney injury in cirrhosis[J]. Critical Care Clinics,2015,31(4):737-750.

[14] CAI JJ,HAN T. Diagnosis and treatment of acute kidney injury in patients with cirrhosis[J]. J Clin Hepatol,2014,30(12):1352-1356.(in Chinese)蔡均均，韩涛．肝硬化患者急性肾损伤的诊断与治疗[J]．临床肝胆病杂志，2014,30(12):1352-1356.

[15] JUSTIN MB,ARUN JS,GUADDALUPE GT,et al. Early trends in cystatin C and outcomes in patients with cirrhosis and acute kidney injury[J]. Int J Nephrol,2014,2014(3):1-8.

[16] VANDREA DS,AOUMEUR HA,OLGA D,et al. Creatinineversus cystatine C-based equations in assessing the renal function of candidates for liver transplantation with cirrhosis[J]. Hepatology,2014,59(4):1522-1531.

[17] MINDIKOGL AL,DOWLING TC,WEIR MR,et al. Performance of chronic kidney disease epidemiology collaboration creatinine-cystatin C equation for estimating kidney function in cirrhosis[J]. Hepatology,2014,59(4):1532-1542.

[18] ALLEN AM,KIM WR,LARSON JJ,et al. Serum cystatin C as an indicator of renal function and mortality in liver transplant recipients[J]. Transplantation,2015,99(7):1431-1435.

[19] PECO-ANTIC'A,IVANIEVIC'I,VULIC'EVIC'I,et al. Biomarkers of acute kidney injury in pediatric cardiac surgery[J]. Clin Biochem,2013,46(13-14):1244-1251.

[20] WAN ZH,WANG JJ,YOU SL,et al. Cystatin C is a biomarker for predicting acute kidney injury in patients with acute-onchronic liver failure[J]. World J Gastroenterol,2013,19(48):9432.

[21] MARKWARDT D,HOLDT L,STEIB C,et al. Plasma cystatin C is a predictor of renal dysfunction,acute-on-chronic liver failure,and mortality in patients with acutely decompensated liver cirrhosis[J]. Hepatology,2017,66(4):1232-1241.

[22] CONTI M,MOUTEREAU S,ZATER M,et al. Urinary cystatin C as a specific marker of tubular dysfunction[J]. Clin Chem Lab Med,2006,44(3):288-291.

[23] LI XP,WU ZP,ZHANG LL,et al. Advances in diagnosis and treatment of patients with acute-on-chronic liver failure complicated by acute kidney injury[J]. J Clin Hepatol,2016,32(9):1688-1693.(in Chinese)李小鹏，吴振平，张伦理，等．慢加急性肝衰竭并发急性肾损伤的诊治进展[J]．临床肝胆病杂志，2016,32(9):1688-1693.

[24] XU SS,WEI XH,LIN W,et al. Clinical significance of platelet count and its dynamic change in patients with acute-onchronic liver failure[J]. J CIin Hepatol,2018,34(4):810-813.(in Chinese)许姗姗，韦新焕，林伟，等．慢加急性肝衰竭患者血小板计数及其动态变化的临床意义[J]．临床肝胆病杂志，2018,34(4):810-813.

[25] SHI XX,ZHANG YQ,ZHU P,et al. Prognostic risk factors in patients with acute-on-chronic hepatitis B liver failure[J]. J Clin Hepatol,2016,32(4):700-705.(in Chinese)石新星，张艳琼，朱鹏，等．乙型肝炎相关慢加急性肝衰竭患者预后的危险因素分析[J]．临床肝胆病杂志，2016,32(4):700-705.

[26] LESURTEL M,GRAF R,ALEIL B,et al. Platelet-derived serotonin mediates liver regeneration[J]. Science,2006,312(5770):104-107.

[27] FENG N,FENG B,XING XM. Value of red blood cell distribution width,platelet count,and lactate level in evaluating the prognosis of patients with acute-on-chronic liver failure after plasma exchange[J]. Clin J Med Offic,2019,47(3):320-322.(in Chinese)冯楠，冯波，邢星敏．红细胞分布宽度、血小板计数与乳酸水平对慢加急性肝衰竭患者经血浆置换治疗预后评估价值[J]．临床军医杂志，2019,47(3):320-322.

[28] MICHAEL M,PATRICK SK,FREDRIC DG,et al. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts[J]. Hepatology,2000,31(4):864-871.

[29] WU TZ,LI J,SHAO L,et al. Development of diagnostic criteria and a prognostic score for hepatitis B virus-related acute-on-chronic liver failure[J]. Gut,2017,67(12):2181-2191.

[30] 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.

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