乙型肝炎病毒相关性急慢性肝功能衰竭患者预后危险因素分析及预后模型的建立

中华传染病杂志 Pub Date : 2019-12-15 DOI:10.3760/CMA.J.ISSN.1000-6680.2019.12.004

Ziyue Li, Shitian Yang, Lingling Wu, Liying Tian, Na Li, Luyuan Ma, Chuan Shen, Ya-dong Wang, Xiao-Jing Wang, Caiyan Zhao

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引用次数: 0

摘要

目的探讨影响乙型肝炎病毒（HBV）相关性急慢性肝功能衰竭（ACLF）患者预后的危险因素，并建立预后模型。方法收集2013年1月1日至2018年11月1日河北医科大学第三医院传染病科收治的193例HBV-ACLF确诊患者作为衍生队列。收集2017年7月1日至2018年11月1日期间入住石家庄市第五医院的35名确诊为HBV-ACLF的患者作为验证队列。观察所有患者在入院第12周的生存情况。采用多元logistic回归分析方法分析与短期预后相关的危险因素，建立并验证了logistic回归方程预测模型。使用受试者操作特征（ROC）曲线评估预后模型的诊断性能，并与终末期肝病（MELD）评分系统、Child-Turcotte-Pugh评分系统、序贯器官衰竭评估（SOFA）评分系统和慢性肝衰竭（CLIF）-SOFA评分系统的模型进行比较。结果多因素logistic回归分析显示年龄（比值比（OR）=2.133，95%可信区间（CI）1.033-4.405）、总胆红素（OR=3.371，95%CI 1.610-7.060）、血清肌酐（OR=4.448，95%CI 1.6 97-11.661）、肝性脑病（OR=5.313，95%CI 2.463-11.461），和腹水（OR=2.959，95%CI 1.410-6.210）是预测HBV-ACLF患者短期预后的独立危险因素。新建立的逻辑回归模型（LRM）=-1.726+0.757×年龄+1.255×总胆红素+1.0492×血清肌酐+1.670×肝性脑病（有=1，无=0）+1.085×腹水（有=1、无=0）。用于预测HBV-ACLF患者短期预后的LRM ROC曲线下面积为0.82（95%CI 0.76-0.88）。此外，MELD、CTP、SOFA、CLIF-SOFA模型的ROC曲线下方面积分别为0.67（95%CI 0.60-0.75）、0.73（95%CI 0.66-0.80）、0.77（95%CI 0.70-0.83）和0.72（95%CI 0.65-0.80）。验证队列的ROC曲线下面积为0.81（95%CI 0.65-0.97）。结论年龄、总胆红素、血清肌酐、肝性脑病和腹水是影响HBV-ACLF预后的独立危险因素。基于这些因素建立的预后模型能够准确预测患者的短期预后，优于MELD、CTP、SOFA和CLIF-SOFA。关键词：乙型肝炎；急性或慢性肝功能衰竭；回归分析；预测模型

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Analysis of prognostic risk factors and establishment of prognosis model in patients with hepatitis B virus-related acute-on-chronic liver failure

Objective To explore the risk factors for prognosis in patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF), and to establish a prognostic model. Methods A total of 193 patients diagnosed with HBV-ACLF who were admitted to the Department of Infectious Diseases of the Third Hospital of Hebei Medical University were collected from 1st January 2013 to 1st November 2018 as a derivation cohort. Thirty-five patients diagnosed with HBV-ACLF who were admitted to the Fifth Hospital of Shijiazhuang during the period from 1st July 2017 to 1st November 2018 were collected as a validation cohort. The survival condition of all patients at week 12 of admission was observed. The risk factors associated with short-term prognosis were analyzed by using multivariate logistic regression analysis, and a logistic regression equation prediction model was established and verified. The diagnostic performance of the prognostic model was evaluated using the receiver operating characteristic (ROC) curve, and was compared with model for end-stage liver disease (MELD) scoring system, Child-Turcotte-Pugh (CTP) scoring system, sequential organ failure assessment (SOFA) scoring system and chronic liver failure (CLIF)-SOFA scoring system. Results Multivariate logistic regression analysis showed that age (odds ratio(OR)=2.133, 95% confidence interval(CI)1.033-4.405), total bilirubin (OR=3.371, 95%CI 1.610-7.060), serum creatinine (OR=4.448, 95%CI 1.697-11.661), hepatic encephalopathy (OR=5.313, 95%CI 2.463-11.461), and ascites (OR=2.959, 95%CI 1.410-6.210) were independent risk factors for predicting the short-term prognosis of patients with HBV-ACLF. The newly established logistic regression model (LRM)=-1.726+ 0.757×age+ 1.215×total bilirubin+ 1.049 2×serum creatinine+ 1.670×hepatic encephalopathy (with=1, without=0) + 1.085×ascites (with=1, without=0). The area under the ROC curve of the LRM for predicting the short-term prognosis of patients with HBV-ACLF was 0.82 (95%CI 0.76-0.88). Furthermore, the areas under the ROC curve of the models of MELD, CTP, SOFA, CLIF-SOFA were 0.67 (95%CI 0.60-0.75), 0.73 (95%CI 0.66-0.80), 0.77 (95%CI 0.70-0.83) and 0.72 (95%CI 0.65-0.80), respectively. The ROC-area under curve of the validation cohort was 0.81 (95%CI 0.65-0.97). Conclusions Age, total bilirubin, serum creatinine, hepatic encephalopathy, and ascites are independent risk factors for the prognosis of HBV-ACLF. The prognostic model established based on these factors can accurately predict the patients′ short-term prognosis, which is superior to MELD, CTP, SOFA and CLIF-SOFA. Key words: Hepatitis B; Acute-on-chronic liver failure; Regression analysis; Prognostic model

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来源期刊

中华传染病杂志

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期刊介绍： The Chinese Journal of Infectious Diseases was founded in February 1983. It is an academic journal on infectious diseases supervised by the China Association for Science and Technology, sponsored by the Chinese Medical Association, and hosted by the Shanghai Medical Association. The journal targets infectious disease physicians as its main readers, taking into account physicians of other interdisciplinary disciplines, and timely reports on leading scientific research results and clinical diagnosis and treatment experience in the field of infectious diseases, as well as basic theoretical research that has a guiding role in the clinical practice of infectious diseases and is closely integrated with the actual clinical practice of infectious diseases. Columns include reviews (including editor-in-chief reviews), expert lectures, consensus and guidelines (including interpretations), monographs, short monographs, academic debates, epidemic news, international dynamics, case reports, reviews, lectures, meeting minutes, etc.