State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou, China.
J Clin Apher. 2020 Apr;35(2):94-103. doi: 10.1002/jca.21762. Epub 2019 Nov 26.
To determine the prognostic risk factors of patients with hepatitis B virus related acute-on-chronic liver failure (HBV-ACLF) treated with plasma exchange (PE)-based artificial liver support system (ALSS), and create a prognostic predictive model.
A total of 304 HBV-ACLF patients who received PE-based ALSS were retrospectively analyzed. Potential prognostic factors on admission associated with survival were investigated. Of note, 101 additional patients were analyzed to validate the performance of the prognostic models.
According to 28-day survival, a total of 207 patients who survived and 97 non-survivors were identified in the derivation group. Overall, 268 (88.2%) ACLF cases were caused by reactivation of HBV. Cox proportional hazards regression model revealed that age, total bilirubin, ln (alpha-fetoprotein [AFP]), encephalopathy (HE) score, sodium level, and international normalized ratio (INR) were independent risk factors of short-term prognosis. We built a model named ALSS-prognosis model (APM) to predict the 28-day survival of HBV-ACLF patients with ALSS; the model APM showed potentially better predictive performance for both the derivation and validation groups than MELD, MELD-Na, and CLIF-C ACLF score.
Low AFP was found to be an independent risk factor for high mortality in HBV-ACLF patients treated with PE-based ALSS. We generated a new model containing AFP, namely APM, which showed potentially better prediction performance than MELD, MELD-Na, and CLIF-C ACLF score for short-term outcomes, and could aid physicians in making optimal therapeutic decisions.
确定接受基于血浆置换（PE）的人工肝支持系统（ALSS）治疗的乙型肝炎病毒相关慢加急性肝衰竭（HBV-ACLF）患者的预后危险因素，并创建一个预后预测模型。
回顾性分析了 304 例接受基于 PE 的 ALSS 治疗的 HBV-ACLF 患者。研究了入院时与生存相关的潜在预后因素。值得注意的是，另外分析了 101 例患者以验证预后模型的性能。
根据 28 天生存率，在推导组中总共确定了 207 例存活患者和 97 例非存活患者。总体而言，268 例（88.2%）ACLF 病例是由乙型肝炎病毒再激活引起的。Cox 比例风险回归模型显示，年龄、总胆红素、ln（甲胎蛋白[AFP]）、肝性脑病（HE）评分、钠水平和国际标准化比值（INR）是短期预后的独立危险因素。我们构建了一个名为 ALSS 预后模型（APM）的模型，用于预测接受 ALSS 治疗的 HBV-ACLF 患者的 28 天生存率；模型 APM 在推导组和验证组中的预测性能均优于 MELD、MELD-Na 和 CLIF-C ACLF 评分。
在接受基于 PE 的 ALSS 治疗的 HBV-ACLF 患者中，低 AFP 被发现是高死亡率的独立危险因素。我们生成了一个包含 AFP 的新模型，即 APM，它在短期预后方面显示出比 MELD、MELD-Na 和 CLIF-C ACLF 评分更好的预测性能，有助于医生做出最佳治疗决策。
