肝损伤的不同定义对重症监护病房继发性肝损伤患者发病率和死亡率的影响

IF 2.7 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva Pub Date : 2024-11-01 DOI:10.1016/j.medin.2024.05.013

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引用次数: 0

摘要

目的研究在同一研究人群中使用不同的肝损伤（HI）定义会如何改变发病率和死亡率，以及哪种定义能最好地诊断继发性肝损伤。以SOFA肝脏标准（SOFA：总胆红素（TBL）> 1.2 mg/dl）为金标准，计算了美国胃肠病学院（ACG）和2019年欧洲肝脏研究协会（EASL）修改后的2017年定义的敏感性、特异性、阳性和阴性预测值以及准确性。结果根据定义的不同，发病率从10%到45%不等（P< 0.005），而死亡率从38%到57%不等。当把 SOFA1.2 (TBL > 1.2 定义作为金标准时，ACG 定义的诊断价值很高，而且发现 HI 是一个独立的危险因素，会使死亡率增加四倍。包括谷丙转氨酶（ALT）、谷草转氨酶（AST）和总胆碱酯酶（TBL）微小升高的定义可预测死亡率，且发病率合理。

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The effect of different definitions of hepatic injury on incidence and mortality rates in the ICU patient population with secondary hepatic injury

Objective

The aim was to investigate how different hepatic injury (HI) definitions used in the same study population change incidence and mortality rates and which would best diagnose secondary HI.

Design

Single-centre retrospective observational cohort study.

Setting

Tertiary hospital ICU, ANKARA, Turkey.

Patients

Four hundred seventy-eight adult patients were included in the study.

Interventions

None.

Main variables of interest

Three definitions of HI were compared. Taking the SOFA hepatic criteria (SOFA: Total bilirubin (TBL) > 1.2 mg/dl) as the gold standard, sensitivity, specificity, positive and negative predictive values, and accuracy of the modified 2017 definition by the American College of Gastroenterology (ACG) and the 2019 European Association for the Study of the Liver (EASL) were calculated.

Results

Incidence rates ranged from 10% to 45% according to the definition (p < 0.005), while mortality rates ranged from 38% to 57%. When the SOFA1.2 (TBL > 1.2 definition was taken as the gold standard, the diagnostic value of the ACG definition was high, and HI was found to be an independent risk factor that increased mortality four times.

Conclusions

According to this study’s results, the incidence and mortality rates of secondary HI vary greatly depending on the definition used. A definition that includes minimal increases in ALT, AST, and TBL predicts mortality with reasonable incidence rates.

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来源期刊

Medicina Intensiva CRITICAL CARE MEDICINE-

CiteScore

2.70

自引率

20.00%

发文量

146

审稿时长

33 days

期刊介绍： Medicina Intensiva is the journal of the Spanish Society of Intensive Care Medicine and Coronary Units (SEMICYUC) and of Pan American and Iberian Federation of Societies of Intensive and Critical Care Medicine. Medicina Intensiva has become the reference publication in Spanish in its field. The journal mainly publishes Original Articles, Reviews, Clinical Notes, Consensus Documents, Images, and other information relevant to the specialty. All works go through a rigorous selection process. The journal accepts submissions of articles in English and in Spanish languages. The journal follows the publication requirements of the International Committee of Medical Journal Editors (ICMJE) and the Committee on Publication Ethics (COPE).