Baquerizo Angeles, Anselmo Dean, Shackleton Christopher, Chen Teng-Wei, Cao Carlos, Weaver Michael, Gornbein Jeffrey, Geevarghese Sunil, Nissen Nicholas, Farmer Douglas, Demetriou Achilles, Busuttil Ronald W
Department of Surgery, Dumont-UCLA Transplant Center, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Transplantation. 2003 Jun 27;75(12):2007-14. doi: 10.1097/01.TP.0000063219.21313.32.
This study analyzes the prognostic significance of serum phosphorus in patients with acute liver failure (ALF).
We performed a retrospective analysis of 112 patients with ALF. Univariate and bivariate analyses based on Kaplan-Meier recovery curves and a multivariate Classification Tree Structure Survival Analysis were performed to identify independent predictors of outcome. The variables analyzed were age, gender, race, ABO blood group, etiology of liver disease, grade of encephalopathy, serum bilirubin, prothrombin time, creatinine, serum phosphorus, phosphorus administered, phosphorus binders, and hemodialysis.
The median follow-up time was 5 days, the median age was 28 years, and 62% of the patients were female. The patients' outcomes were as follows: 28% recovered, 52% required orthotopic liver transplantation, and 20% died. White patients showed the best prognosis (58% recovered in the first week), and Hispanics showed the worst prognosis (0.3% recovered at 1 week) (P=0.0001). Encephalopathy and bilirubin were significant predictors of recovery (P<0.0001 and P=0.004). The analysis of the serum phosphorus showed a statistically significant better prognosis in patients with low phosphorus (P<0.001). The recovery rate at 1 week was 74% in patients with serum phosphorus less than 2.5 mg/dL, 45% if phosphorus ranged between 2.5 to 5 mg/dL, and 0% if phosphorus was more than 5 mg/dL. The bivariate analysis on the effects of phosphorus administration showed that phosphorus replacement was associated with a significant improvement in recovery in patients with low (P<0.004) or normal serum phosphorus levels (P<0.017)
Hypophosphatemia and early phosphorus administration are associated with a good prognosis in ALF, whereas hyperphosphatemia is predictive of poor recovery.
本研究分析血清磷在急性肝衰竭（ALF）患者中的预后意义。
我们对112例ALF患者进行了回顾性分析。基于Kaplan-Meier恢复曲线进行单变量和双变量分析，并采用多变量分类树结构生存分析来确定结局的独立预测因素。分析的变量包括年龄、性别、种族、ABO血型、肝病病因、肝性脑病分级、血清胆红素、凝血酶原时间、肌酐、血清磷、补充的磷、磷结合剂和血液透析。
中位随访时间为5天，中位年龄为28岁，62%的患者为女性。患者的结局如下：28%康复，52%需要原位肝移植，20%死亡。白人患者预后最佳（第一周康复率为58%），西班牙裔患者预后最差（1周时康复率为0.3%）（P = 0.0001）。肝性脑病和胆红素是康复的显著预测因素（P < 0.0001和P = 0.004）。血清磷分析显示，低磷患者的预后在统计学上显著更好（P < 0.001）。血清磷低于2.5mg/dL的患者1周时的康复率为74%，磷在2.5至5mg/dL之间的患者为45%，磷高于5mg/dL的患者为0%。关于补充磷效果的双变量分析表明，在低磷（P < 0.004）或血清磷水平正常（P < 0.017）的患者中，补充磷与康复的显著改善相关。
低磷血症和早期补充磷与ALF的良好预后相关，而高磷血症预示着康复不良。
