乙型肝炎病毒相关性急慢性肝衰竭肝移植受者生存预后的影响因素

IF 2.7 4区 医学 Q2 Medicine
Zhen‐jie Zhou, Junfang Yi, Qiang Li, Wei Hu, Guangshun Chen, Z. Si, Jiequn Li
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引用次数: 1

摘要

目的肝移植(LT)受者合并乙型肝炎病毒相关急性-慢性肝衰竭(HBV-ACLF)的预后因素尚不清楚。本研究评估了影响HBV-ACLF肝移植患者生存的危险因素,并确定了评估患者预后的最佳评分系统。方法本回顾性研究纳入323例接受肝移植的HBV-ACLF相关患者,分别包括112例、146例和65例HBV-ACLF 1级、2级和3级患者。采用Kaplan-Meier法估计总生存期(OS),采用多变量Cox比例风险模型分析与生存相关的因素。采用受试者工作特征(ROC)曲线分析比较移植前预后评分系统。结果HBV-ACLF 3级患者的1年生存率(80.0%)明显低于1级(93.8%)和2级(91.8%)患者(p=0.0063)。Cox多因素分析显示,年龄>53岁(风险比(HR) 3.731;95%可信区间(CI) 1.640-8.407),白细胞计数>8.6 × 109/L (HR 4.544;95% ci 1.140-18.107), hbv - aclf3 (hr 2.729;95% CI 1.050-7.096),冷缺血时间>8.5小时(HR 2.867;95% CI, 1.38-5.921)是1年生存率的独立预后。移植前评分系统的比较显示,慢性肝衰竭-联合ACLF评分(cif -c ACLF)在预测这些患者的1年OS方面优于COSSH-ACLF、MELD- na和MELD评分。结论年龄>53岁、WBC计数>8.6 × 109/L、HBV-ACLF 3级、冷缺血时间>8.5小时是HBV-ACLF肝移植患者OS的独立预后因素。在预测这些患者的1年OS方面,CLIF-C ACLFs优于其他评分方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Factors Prognostic of Survival in Liver Transplant Recipients with Hepatitis B Virus Related Acute-on-Chronic Liver Failure
Objectives Factors prognostic of survival in liver transplant (LT) recipients with hepatitis B virus related acute-on-chronic liver failure (HBV-ACLF) remain unclear. This study evaluated risk factors for survival in LT recipients with HBV-ACLF and determined the scoring system optimal for assessing patient prognosis. Methods This retrospective study included 323 HBV-ACLF related patients undergoing LT, including 112, 146, and 65 patients with HBV-ACLF grades 1, 2, and 3, respectively. Overall survival (OS) was estimated by the Kaplan–Meier method, and factors associated with survival were analysed by multivariate Cox proportional hazards models. Pretransplant prognostic scoring systems were compared by receiver operating characteristic (ROC) curve analysis. Results The one-year survival rate was significantly lower in HBV-ACLF grade 3 (80.0%) than in grades 1 (93.8%) and 2 (91.8%) recipients (p=0.0063). Cox multivariate analysis showed that age >53 years (hazard ratio (HR) 3.731; 95% confidence interval (CI) 1.640–8.407), WBC count >8.6 × 109/L (HR 4.544; 95% CI 1.140–18.107), HBV-ACLF 3 (HR 2.729; 95% CI 1.050–7.096), and cold ischaemia time >8.5 hours (HR 2.867; 95% CI, 1.38–5.921) were independently prognostic of 1-year survival. Comparisons of pretransplant scoring systems showed that chronic liver failure-consortium ACLF score (CLIF-C ACLFs) was superior to COSSH-ACLF, MELD-Na, and MELD scores in predicting 1-year OS in these patients. Conclusions Age >53 years, WBC counts >8.6 × 109/L, HBV-ACLF grade 3, and cold ischaemia time >8.5 hours are independently prognostic of OS in LT recipients with HBV-ACLF. CLIF-C ACLFs is superior to other scoring methods in predicting 1-year OS in these patients.
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来源期刊
CiteScore
4.80
自引率
0.00%
发文量
0
审稿时长
37 weeks
期刊介绍: Canadian Journal of Gastroenterology and Hepatology is a peer-reviewed, open access journal that publishes original research articles, review articles, and clinical studies in all areas of gastroenterology and liver disease - medicine and surgery. The Canadian Journal of Gastroenterology and Hepatology is sponsored by the Canadian Association of Gastroenterology and the Canadian Association for the Study of the Liver.
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