Li Ning, Huang Chong, Yu Kang-Kang, Lu Qing, Shi Guang-Feng, Zheng Jian-Ming
Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China.
Medicine (Baltimore). 2017 Apr;96(17):e6802. doi: 10.1097/MD.0000000000006802.
Acute-on-chronic liver failure (ACLF) in chronic hepatitis B (CHB) patients has a high short-term mortality. Identification of effective models to predict the short-term mortality may enable early intervention and improve patients' prognosis. We aim to assess the performance of the CLIF Consortium Organ Failure score (CLIF-C OFs), CLIF sequential organ failure assessment score (CLIF-SOFAs), CLIF Consortium ACLF score (CLIF-C ACLFs), ACLF grade, and model for end-stage liver disease score (MELDs) in predicting the short-term mortality in CHB patients with ACLF.Among the 155 consecutive adult patients with liver failure as a discharge diagnosis were screened, and all the patients were treated at the Department of Infectious Diseases, Huashan Hospital, Fudan University (Shanghai, China) from January 2010 to February 2016. The diagnosis of ACLF was based on the criteria formalized by the ACLF consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL). Diagnostic accuracy for predicting short-term (28-day) mortality was calculated for CLIF-C OFs, CLIF-SOFAs, CLIF-C ACLFs, ACLF grade, and MELDs in all patients.One hundred fifty-five consecutive adult liver failure patients were screened and 85 patients including 73 males and 12 females were enrolled. Overall, the 28-day transplant-free mortality was 32% in all patients, and 100% in those with severe early course (ACLF-3). The area under the receiver operating characteristic curve (AUROC) of CLIF-C OFs (AUROC: 0.906, P = .0306, compared with MELDs) was higher than those of CLIF-SOFAs (AUROC: 0.876), CLIF-C ACLFs (AUROC: 0.858), ACLF grade (AUROC: 0.857), and MELDs (AUROC: 0.838) for predicting short-term mortality. The cut-point for baseline CLIF-C OFs in predicting death was 8.5, with 67% sensitivity, 90% specificity, and AUROC of 0.906 (95% CI: 0.8450-0.9679).The results indicate that short-term mortality is high in patients with ACLF and CLIF Consortium Organ Failure score is superior to MELD, CLIF SOFA, and CLIF-C ACLF in predicting its short-term mortality.
慢性乙型肝炎(CHB)患者的慢加急性肝衰竭(ACLF)短期死亡率很高。识别有效的预测短期死亡率的模型可能有助于早期干预并改善患者预后。我们旨在评估CLIF联盟器官衰竭评分(CLIF-C OFs)、CLIF序贯器官衰竭评估评分(CLIF-SOFAs)、CLIF联盟ACLF评分(CLIF-C ACLFs)、ACLF分级以及终末期肝病模型评分(MELDs)在预测ACLF的CHB患者短期死亡率方面的表现。
在155例以肝衰竭作为出院诊断的连续成年患者中进行筛选,所有患者均于2010年1月至2016年2月在复旦大学附属华山医院(中国上海)感染科接受治疗。ACLF的诊断基于亚太肝病研究协会(APASL)ACLF共识推荐所规定的标准。计算CLIF-C OFs、CLIF-SOFAs、CLIF-C ACLFs、ACLF分级和MELDs对所有患者预测短期(28天)死亡率的诊断准确性。
筛选出155例连续的成年肝衰竭患者,纳入85例患者,其中男性73例,女性12例。总体而言,所有患者的28天无移植死亡率为32%,早期病程严重(ACLF-3)的患者为100%。在预测短期死亡率方面,CLIF-C OFs的受试者工作特征曲线下面积(AUROC:0.906,P = 0.0306,与MELDs相比)高于CLIF-SOFAs(AUROC:0.876)、CLIF-C ACLFs(AUROC:0.858)、ACLF分级(AUROC:0.857)和MELDs(AUROC:0.838)。预测死亡的基线CLIF-C OFs切点为8.5,敏感性为67%,特异性为90%,AUROC为0.906(95%CI:0.8450 - 0.9679)。
结果表明,ACLF患者的短期死亡率很高,且CLIF联盟器官衰竭评分在预测其短期死亡率方面优于MELD、CLIF SOFA和CLIF-C ACLF。