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血清铁蛋白作为失代偿期慢性肝病患者30天死亡率的预测指标。

Serum ferritin as a predictor of 30 days mortality in Patients of decompensated chronic liver disease.

作者信息

Umer Naseer, Makki Mujeeb Ullah, Kiran Shagufta Kunwal, Jadoon Nauman Arif

机构信息

Department of Medicine, Services Hospital, Lahore, Pakistan.

Ittefaq Hospital, Lahore, Pakistan.

出版信息

J Ayub Med Coll Abbottabad. 2017 Jul-Sep;29(3):415-418.

Abstract

BACKGROUND

Serum ferritin is marker for hepatic neco-inflammation and known 1 year mortality predictor in post-transplant patients. However, data on utility as early mortality predictor in patient of cirrhosis is scarce. We investigated whether ferritin can be used as one month mortality predictor in patients of decompensated cirrhosis.

METHODS

The study cohort included 132 patients in whom predictors of mortality were studied.

RESULTS

One hundred and thirty-two patients with 77 (58.33%) male with a mean age of 54 (±8.3) years with decompensated cirrhosis were followed for 30 days. enrolled for study. Majority of the patients had hepatitis C (71.4%) with 19 (14.3%) cases of hepatitis B related cirrhosis and 5.3%, 4.5% and 2.3% comprising alcoholic, autoimmune and Wilsons related decompensated cirrhosis respectively. Ninety-one (69.42%) patients were alive at end of study period, with serum ferritin levels were significantly different between the survivors and the non-survivors (p< .001) and showed significant correlation with CTP Score (p <.001) and MELD Score (p <.001). Regarding ferritin level and outcome, 76 (all alive) had ferritin level <200 ng/ml, 26 (13 alive, 13 died) had ferritin level between 200-400 ng/ml and 30 (2 alive, 28 died) had ferritin level >400 ng/ml (p= .001). With increasing ferritin level, CTP class as well as MELD score increased. Patients with raised ferritin levels were more likely to die compared to those with lower ferritin levels (p <.001).

CONCLUSIONS

Serum ferritin levels correlate with severity of liver disease and are associated with early mortality in patients of decompensated cirrhosis independent of MELD score.

摘要

背景

血清铁蛋白是肝坏死性炎症的标志物,也是移植后患者1年死亡率的已知预测指标。然而,关于其作为肝硬化患者早期死亡率预测指标的效用的数据却很稀少。我们调查了铁蛋白是否可作为失代偿期肝硬化患者1个月死亡率的预测指标。

方法

研究队列包括132例对死亡率预测指标进行研究的患者。

结果

132例失代偿期肝硬化患者,其中77例(58.33%)为男性,平均年龄54(±8.3)岁,随访30天并纳入研究。大多数患者为丙型肝炎(71.4%),19例(14.3%)为乙型肝炎相关肝硬化,酒精性、自身免疫性和威尔逊病相关失代偿期肝硬化分别占5.3%、4.5%和2.3%。91例(69.42%)患者在研究期末存活,幸存者和非幸存者的血清铁蛋白水平存在显著差异(p<0.001),且与CTP评分(p<0.001)和MELD评分(p<0.001)显著相关。关于铁蛋白水平与预后,76例(均存活)铁蛋白水平<200 ng/ml,26例(13例存活,13例死亡)铁蛋白水平在200 - 400 ng/ml之间,30例(2例存活,28例死亡)铁蛋白水平>400 ng/ml(p = 0.001)。随着铁蛋白水平升高,CTP分级以及MELD评分均升高。铁蛋白水平升高的患者比铁蛋白水平较低的患者更易死亡(p<0.001)。

结论

血清铁蛋白水平与肝病严重程度相关,且与失代偿期肝硬化患者的早期死亡率相关,独立于MELD评分。

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