吲哚菁绿清除试验联合终末期肝病模型（MELD）评分预测急性肝衰竭患者的短期预后

Indocyanine green clearance test combined with MELD score in predicting the short-term prognosis of patients with acute liver failure.

作者信息

Feng Hong-Ling, Li Qian, Wang Lin, Yuan Gui-Yu, Cao Wu-Kui

机构信息

Intensive Care Unit, Tianjin Second People's Hospital, Tianjin 300192, China.

出版信息

Hepatobiliary Pancreat Dis Int. 2014 Jun;13(3):271-5. doi: 10.1016/s1499-3872(14)60040-0.

DOI:10.1016/s1499-3872(14)60040-0

PMID:24919610

Abstract

BACKGROUND

Acute liver failure (ALF) is an acute severe deterioration of liver function with high mortality. Early and accurate prognostic assessment of patients with ALF is critically important. Although the model for end-stage liver disease (MELD) scores and King's College Hospital (KCH) criteria are well-accepted as predictive tools, their accuracy is unsatisfactory. The indocyanine green (ICG) clearance test (ICGR15, ICG retention rate at the 15 minutes) is a sensitive indicator of liver function. In this study, we investigated the efficacy of the ICGR15 for the short-term prognosis in patients with ALF. We compared the predictive value of ICGR15 with the MELD scores and KCH criteria.

METHODS

Sixty-nine patients who had been diagnosed with ALF were recruited retrospectively. ICGR15 had been performed by ICG pulse spectrophotometry and relevant clinical and laboratory indices were analyzed within 24 hours of diagnosis. In addition, the MELD scores and KCH criteria were calculated.

RESULTS

The three-month mortality of all patients was 47.83%. Age, serum total bilirubin and creatinine concentrations, international normalized ratio for prothrombin time, ICGR15, MELD scores and KCH criteria differed significantly between surviving and deceased patients. A positive correlation was observed between ICGR15 and MELD scores (r=0.328, P=0.006). The ICGR15-MELD model, Logit(P)=0.096XICGR15+0.174XMELD score-9.346, was constructed by logistic regression analysis. The area under the receiver operating characteristic curve was 0.855. When set the cut-off point to -0.4684, the sensitivity was 87.90% and specificity, 72.20%. The area under the receiver operating characteristic curve of the ICGR15-MELD model (0.855) was significantly higher than that of the ICGR15 (0.793), MELD scores (0.776) and KCH criteria (0.659). Based on this cut-off value, the patients were divided into two groups. The mortality was 74.36% in the first group (ICGR15-MELD≥-0.4686) and 13.33% in the second group (ICGR15-MELD<-0.4686), with a significant difference between the two groups (X(2)=25.307, P=0.000).

CONCLUSION

The ICGR15-MELD model is superior to the ICGR15, MELD scores, and KCH criteria in predicting the short-term prognosis of patients with ALF.

摘要

背景

急性肝衰竭（ALF）是肝功能的急性严重恶化，死亡率很高。对ALF患者进行早期准确的预后评估至关重要。尽管终末期肝病模型（MELD）评分和国王学院医院（KCH）标准作为预测工具已被广泛接受，但其准确性并不令人满意。吲哚菁绿（ICG）清除试验（ICGR15，即15分钟时的ICG潴留率）是肝功能的敏感指标。在本研究中，我们调查了ICGR15对ALF患者短期预后的有效性。我们比较了ICGR15与MELD评分和KCH标准的预测价值。

方法

回顾性招募69例被诊断为ALF的患者。通过ICG脉冲分光光度法检测ICGR15，并在诊断后24小时内分析相关临床和实验室指标。此外，计算MELD评分和KCH标准。

结果

所有患者的3个月死亡率为47.83%。存活患者和死亡患者在年龄、血清总胆红素和肌酐浓度、凝血酶原时间国际标准化比值、ICGR15、MELD评分和KCH标准方面存在显著差异。ICGR15与MELD评分之间存在正相关（r = 0.328，P = 0.006）。通过逻辑回归分析构建了ICGR15 - MELD模型，Logit(P)=0.096×ICGR15 + 0.174×MELD评分 - 9.346。受试者工作特征曲线下面积为0.855。当将截断点设为 - 0.4684时，敏感性为87.90%，特异性为72.20%。ICGR15 - MELD模型的受试者工作特征曲线下面积（0.855）显著高于ICGR15（0.793）、MELD评分（0.776）和KCH标准（0.659）。基于此截断值，将患者分为两组。第一组（ICGR15 - MELD≥ - 0.4686）的死亡率为74.36%，第二组（ICGR15 - MELD < - 0.4686）的死亡率为13.33%，两组之间存在显著差异（X(2)=25.307，P = 0.000）。