Zhang Qianqian, Guo Xiaolin, Zhao Shixing, Pang Xiaoli, Wang Yang, Zhang Yujiao, Chi Baorong
Department of Hepatobiliary and Pancreatic Diseases, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China.
Department of Intensive Care Unit, Affiliated Hospital of Jining Medical University, Jining, Shandong 272000, P.R. China.
Exp Ther Med. 2016 Apr;11(4):1348-1354. doi: 10.3892/etm.2016.3037. Epub 2016 Jan 29.
The present study aimed to analyze the prognostic factors of acute-on-chronic liver failure (ACLF), with the perspective of an improved selection of optimal therapeutic schemes. A retrospective analysis was used to study 164 patients with ACLF hospitalized between 2010 and 2014 in a single center. Patients were divided into favorable and unfavorable groups, according to the treatment outcomes. General characteristics and clinical manifestations were analyzed to determine whether they would affect the prognosis of the patients with ACLF, with a particular focus on the scoring systems Child-Pugh, model for end-stage liver disease (MELD), MELD with incorporation of sodium (MELD-Na), MELD and serum sodium ratio (MESO) and integrated MELD (iMELD). Hepatitis B virus infection was the predominant cause of ACLF, accounting for 88 cases (53.7%). Age, prothrombin time, thrombin time, international normalized ratio (INR), prothrombin activity, serum sodium, albumin, total bilirubin, serum creatinine, platelets, fasting blood sugar, infections, hepatic encephalopathy, hepatorenal syndrome (HRS), and electrolyte disorder were revealed to be associated with prognosis. Age, serum sodium, INR, HRS, and infection were independent prognostic risk factors, as determined by multivariate analysis. Child-Pugh, MELD, MELD-Na, MESO and iMELD scoring systems all demonstrated adequate predictive values, with MELD-Na as the most effective scoring system. In conclusion, age, hyponatremia, INR, HRS and bacterial or fungal infections were reported to be independent prognostic risk factors for ACLF. Among the various liver function scoring systems, MELD-Na was the most accurate in predicting the prognosis of ACLF.
本研究旨在从优化治疗方案选择的角度分析慢加急性肝衰竭（ACLF）的预后因素。采用回顾性分析方法，对2010年至2014年在单中心住院的164例ACLF患者进行研究。根据治疗结果将患者分为预后良好组和预后不良组。分析一般特征和临床表现，以确定它们是否会影响ACLF患者的预后，特别关注Child-Pugh评分系统、终末期肝病模型（MELD）、包含钠的MELD（MELD-Na）、MELD与血清钠比值（MESO）以及综合MELD（iMELD）。乙型肝炎病毒感染是ACLF的主要病因，占88例（53.7%）。结果显示，年龄、凝血酶原时间、凝血酶时间、国际标准化比值（INR）、凝血酶原活动度、血清钠、白蛋白、总胆红素、血清肌酐、血小板、空腹血糖、感染、肝性脑病、肝肾综合征（HRS）和电解质紊乱与预后相关。多因素分析确定年龄、血清钠、INR、HRS和感染是独立的预后危险因素。Child-Pugh、MELD、MELD-Na、MESO和iMELD评分系统均显示出足够的预测价值，其中MELD-Na是最有效的评分系统。总之，年龄、低钠血症、INR、HRS以及细菌或真菌感染被报道为ACLF的独立预后危险因素。在各种肝功能评分系统中，MELD-Na在预测ACLF预后方面最为准确。
