Yi Zhao-Quan, Lu Meng-Hou, Xu Xu-Wen, Fu Xiao-Yu, Tan De-Ming
Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, 410008, China.
J Huazhong Univ Sci Technolog Med Sci. 2015 Feb;35(1):87-92. doi: 10.1007/s11596-015-1394-5. Epub 2015 Feb 12.
Patients with acute-on-chronic hepatitis B liver failure (HBV-ACLF) show high morbidity and mortality. Independent prognostic predictors of short-term HBV-ACLF mortality include the Child-Turcotte-Pugh (CTP) score, the model for end-stage liver disease (MELD) score, other MELD-based indices and the dynamic changes in these indices. The aims of this study were to evaluate the existing prognostic scores in a large cohort of HBV-ACLF patients and create a new predictive model. We retrospectively reviewed 392 HBV-ACLF patients from December 2008 to November 2011 and evaluated their 3-month survival. The predictive accuracy of CTP, MELD and MELD-based indices and the dynamic changes in the MELD-related scores (Δ scoring systems) upon admission and after two weeks of treatment were compared using the area under the receiver operating characteristic (ROC) curve method. Life-threatening factors and a series of bio-clinical parameters were studied by univariate and multivariate analyses. Among the existing scores, MELD had the best predictive ability. However, our new regression model provided an area under the curve of 0.930 ± 0.0161 (95% CI: 0.869 to 0.943), which was significantly larger than that obtained with the MELD score at admission and after two weeks of treatment as well as with the dynamic changes of the MELD score (0.819, 0.921, and 0.826, respectively) (Z=3.542, P=0.0004). In a large cohort of patients retrospectively reviewed for this study, our prognostic model was superior to the MELD score and is, therefore, a promising predictor of short-term survival in patients with HBV-ACLF.
慢性乙型肝炎急性肝衰竭（HBV-ACLF）患者的发病率和死亡率很高。HBV-ACLF短期死亡率的独立预后预测指标包括Child-Turcotte-Pugh（CTP）评分、终末期肝病模型（MELD）评分、其他基于MELD的指标以及这些指标的动态变化。本研究的目的是评估一大群HBV-ACLF患者中现有的预后评分，并创建一个新的预测模型。我们回顾性分析了2008年12月至2011年11月期间的392例HBV-ACLF患者，并评估了他们的3个月生存率。使用受试者工作特征（ROC）曲线下面积法比较了CTP、MELD和基于MELD的指标的预测准确性，以及入院时和治疗两周后的MELD相关评分（Δ评分系统）的动态变化。通过单因素和多因素分析研究了危及生命的因素和一系列生物临床参数。在现有的评分中，MELD具有最佳的预测能力。然而，我们的新回归模型的曲线下面积为0.930±0.0161（95%CI：0.869至0.943），显著大于入院时、治疗两周后的MELD评分以及MELD评分的动态变化所获得的曲线下面积（分别为0.819、0.921和0.826）（Z=3.542，P=0.0004）。在本研究回顾性分析的一大群患者中，我们的预后模型优于MELD评分，因此是HBV-ACLF患者短期生存的一个有前景的预测指标。
