Liu Longgen, Lu Jianchun, Ye Chunyan, Lin Lin, Zheng Shuqin, Zhang Hongyu, Lan Qing, Xue Yuan
Institute for the Study of Liver Diseases, The Third People's Hospital of Changzhou, Changzhou, Jiangsu 213000, P.R. China.
Department of Liver Diseases, The Third People's Hospital of Changzhou, Changzhou, Jiangsu 213000, P.R. China.
Biomed Rep. 2018 Feb;8(2):166-171. doi: 10.3892/br.2017.1027. Epub 2017 Dec 13.
Acute-on-chronic liver failure (ACLF) is a syndrome with a high rate of short-term mortality, and clinically it is important to identify patients at high risk of mortality. The present study evaluated the value of osteopontin (OPN) in the prediction of 90-day mortality in patients with ACLF. A total of 54 patients with HBV-associated ACLF were enrolled, and serum OPN levels were determined in a prospective, observational study design. Survival analysis was performed using Kaplan-Meier curves, and multivariate Cox proportional hazards regression was used to analyze independent risk factors of mortality. Serum OPN was significantly higher in HBV-ACLF patients compared with patients with chronic hepatitis B and healthy controls (both P<0.01), and furthermore, was higher in those patients who succumbed to HBV-ACLF compared with surviving patients (P<0.05). OPN level positively correlated with total bilirubin (r=0.554, P<0.001), Model for End-Stage Liver Disease (MELD) score (r=0.234, P=0.038), MELD-Na score (r=0.379, P=0.005) and monocyte count (r=0.282, P=0.039), and OPN was an independent risk factor for 90-day mortality in ACLF (P=0.021, odds ratio=1.104, 95% confidence interval: 1.003-1.116). Furthermore, ACLF patients were stratified into three groups according to serum OPN levels (low mortality risk: <6,135 ng/ml; intermediate risk: 6,135-9,043 ng/ml; and high risk: >9,043 ng/ml), for which the 90-day mortality rates were 27.78 (5/18), 52.94 (9/17) and 73.68% (14/19), respectively, and those in the high risk had a poorer prognosis compared with the low risk group (P=0.009). In conclusion, serum OPN may be an independent risk factor associated with HBV-ACLF prognosis.
慢加急性肝衰竭（ACLF）是一种短期死亡率很高的综合征，临床上识别高死亡风险患者很重要。本研究评估了骨桥蛋白（OPN）在预测ACLF患者90天死亡率中的价值。共纳入54例HBV相关ACLF患者，采用前瞻性观察性研究设计测定血清OPN水平。使用Kaplan-Meier曲线进行生存分析，并采用多因素Cox比例风险回归分析死亡的独立危险因素。与慢性乙型肝炎患者和健康对照相比，HBV-ACLF患者的血清OPN显著更高（均P<0.01），此外，死于HBV-ACLF的患者血清OPN高于存活患者（P<0.05）。OPN水平与总胆红素呈正相关（r=0.554，P<0.001）、终末期肝病模型（MELD）评分（r=0.234，P=0.038）、MELD-Na评分（r=0.379，P=0.005）和单核细胞计数呈正相关（r=0.282，P=0.039），且OPN是ACLF患者90天死亡的独立危险因素（P=0.021，比值比=1.104，95%置信区间：1.003-1.116）。此外，根据血清OPN水平将ACLF患者分为三组（低死亡风险：<6,135 ng/ml；中度风险：6,135-9,043 ng/ml；高风险：>9,043 ng/ml），其90天死亡率分别为27.78%（5/18）、52.94%（9/17）和73.68%（14/19），高风险组患者的预后比低风险组差（P=0.009）。总之，血清OPN可能是与HBV-ACLF预后相关的独立危险因素。
