慢性乙型肝炎急性肝衰竭的条件生存估计：基于多中心队列的动态预测
Conditional survival estimate of acute-on-chronic hepatitis B liver failure: a dynamic prediction based on a multicenter cohort.
作者信息
Zheng Ming-Hua, Wu Sheng-Jie, Shi Ke-Qing, Yan Hua-Dong, Li Hai, Zhu Gui-Qi, Xie Yao-Yao, Wu Fa-Ling, Chen Yong-Ping
机构信息
Department of Infection and Liver Diseases, Liver Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.
Institute of Hepatology, Wenzhou Medical University, Wenzhou 325000, China.
出版信息
Oncotarget. 2015 Sep 15;6(27):23261-71. doi: 10.18632/oncotarget.4666.
OBJECTIVES
Counseling patients with acute-on-chronic hepatitis B liver failure (ACHBLF) on their individual risk of short-term mortality is challenging. This study aimed to develop a conditional survival estimate (CSE) for predicting individualized mortality risk in ACHBLF patients.
METHODS
We performed a large prospective cohort study of 278 ACHBLF patients from December 2010 to December 2013 at three participating medical centers. The Kaplan-Meier method was used to calculate the cumulative overall survival (OS). Cox proportional hazard regression models were used to analyze the risk factors associated with OS. 4-week CSE at "X" week after diagnostic established were calculated as CS4 = OS(X+4)/OS(X).
RESULTS
The actual OS at 2, 4, 6, 8, 12 weeks were 80.5%, 71.8%, 69.3%, 66.0% and 63.7%, respectively. Using CSE, the probability of surviving an additional 4 weeks, given that the patient had survived for 1, 3, 5, 7, 9 weeks was 74%, 86%, 92%, 93%, 97%, respectively. Patients with worse prognostic feathers, including MELD > 25, Child grade C, age > 45, HE, INR > 2.5, demonstrated the greatest increase in CSE over time, when compared with the "favorable" one (Δ36% vs. Δ10%; Δ28% vs. Δ16%; Δ29% vs. Δ15%; Δ60% vs. Δ12%; Δ33% vs. Δ12%; all P < 0.001; respectively).
CONCLUSIONS
This easy-to-use CSE can accurately predict the changing probability of survival over time. It may facilitate risk communication between patients and physicians.
目的
向慢性乙型肝炎急性肝衰竭（ACHBLF）患者咨询其短期死亡的个体风险具有挑战性。本研究旨在开发一种条件生存估计（CSE）方法，以预测ACHBLF患者的个体死亡风险。
方法
我们于2010年12月至2013年12月在三个参与研究的医疗中心对278例ACHBLF患者进行了一项大型前瞻性队列研究。采用Kaplan-Meier方法计算累积总生存率（OS）。使用Cox比例风险回归模型分析与OS相关的危险因素。诊断确立后“X”周的4周CSE计算为CS4 = OS(X + 4)/OS(X)。
结果
2周、4周、6周、8周、12周时的实际OS分别为80.5%、71.8%、69.3%、66.0%和63.7%。使用CSE，假设患者已存活1周、3周、5周、7周、9周，再存活4周的概率分别为74%、86%、92%、93%、97%。与“有利”患者相比，预后较差的患者，包括终末期肝病模型（MELD）> 25、Child C级、年龄> 45岁、肝性脑病（HE）、国际标准化比值（INR）> 2.5，其CSE随时间的增加幅度最大（分别为Δ36%对Δ10%；Δ28%对Δ16%；Δ29%对Δ15%；Δ60%对Δ12%；Δ33%对Δ12%；所有P < 0.001）。
结论
这种易于使用的CSE可以准确预测生存概率随时间的变化。它可能有助于患者与医生之间的风险沟通。
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