Li Chen, Zhu Bing, Lv Sa, You Shaoli, Xin Shaojie
Liver Failure Treatment and Research Center, 302 Military Hospital, Beijing, P.R. China.
Medicine (Baltimore). 2018 Aug;97(34):e11915. doi: 10.1097/MD.0000000000011915.
This study aimed to establish a new model for predicting acute-on-chronic liver failure (ACLF) (defined by the Chinese Medical Association), which potentially occurs among patients with acute deterioration (AD) of hepatitis B virus (HBV)-related chronic liver disease (CLD).A total of 754 patients with AD of HBV-related CLD (total bilirubin (TBIL) > 51.3 μmol/L and prothrombin activity (PTA) < 60%, 40% < PTA < 60% when TBIL ≥ 171.1 μmol/L) were retrospectively analyzed and divided into a training cohort (580 patients) and a validation cohort (174 patients). The ACLF occurrence probability of these patients was statistically analyzed within 4 weeks. In the training cohort, multivariate logistic regression analysis was performed to determine the independent predictors of ACLF occurrence and to develop a new prediction model. The validation cohort was utilized to verify and evaluate the value of the new prediction model.Within 4 weeks, 9.9% of the patients progressed to ACLF (12.0 ± 6.7 days). The new prediction model was characterized by R = 3.090 + 0.035 × Age (years) - 0.050 × PTA (%) + 0.005 × TBIL (μmol/L) + 0.044 × D/T (%) - 0.072 × Na (mmol/L) + 0.180 × HBV DNA (log10IU/mL). The areas under the receiver operating characteristic curves of the training and validation cohorts in the new model were higher than those in the model for end-stage liver disease.The new prediction model could be used by clinicians to recognize patients with AD of HBV-related CLD with high risks of progressing to ACLF.
本研究旨在建立一种预测慢性乙型肝炎病毒（HBV）相关慢性肝病（CLD）急性恶化（AD）患者中可能出现的急性-on-慢性肝衰竭（ACLF）（由中华医学会定义）的新模型。对754例HBV相关CLD急性恶化患者（总胆红素（TBIL）>51.3μmol/L且凝血酶原活动度（PTA）<60%，当TBIL≥171.1μmol/L时40%<PTA<60%）进行回顾性分析，并分为训练队列（580例患者）和验证队列（174例患者）。对这些患者在4周内发生ACLF的概率进行统计学分析。在训练队列中，进行多因素逻辑回归分析以确定ACLF发生的独立预测因素并建立新的预测模型。验证队列用于验证和评估新预测模型的价值。在4周内，9.9%的患者进展为ACLF（12.0±6.7天）。新预测模型的特征为R = 3.090 + 0.035×年龄（岁） - 0.050×PTA（%） + 0.005×TBIL（μmol/L） + 0.044×D/T（%） - 0.072×Na（mmol/L） + 0.180×HBV DNA（log10IU/mL）。新模型中训练队列和验证队列的受试者工作特征曲线下面积高于终末期肝病模型中的曲线下面积。新预测模型可供临床医生用于识别HBV相关CLD急性恶化且进展为ACLF风险高的患者。
