Cell-gene Therapy Translational Medicine Research Center, Key Laboratory of Liver Disease of Guangdong Province, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.
Department of Laboratory Medicine, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.
BMC Gastroenterol. 2020 Jun 15;20(1):188. doi: 10.1186/s12876-020-01324-w.
Acute-on-chronic liver failure (ACLF) is a clinic syndrome with substantial high short-term mortality. It is very important to stratify patients according to prognosis to decide management strategy. This study aimed to formulate and validate a nomogram model based on blood lipoprotein for prediction of 3-month mortality in patients with hepatitis B virus (HBV)-related ACLF.
Data on 393 consecutive patients who were diagnosed as HBV-related ACLF at the Third Affiliated Hospital of Sun Yat-sen University between June 1, 2013, and February 1, 2015, were prospectively collected. Of these, 260 patients who were collected in an earlier period formed the training cohort for the development of nomogram, while 133 patients who were collected thereafter formed the validation cohort for confirming the performance of nomogram.
Multivariate analysis showed that low density lipoprotein cholesterol (LDL-C), age, prothrombin time, and creatinine were independently associated with 3-month mortality of patients with HBV-related ACLF. Kaplan-Meier survival analysis revealed that the high LDL-C (LDL-C ≥ 1.0 mmol/L, cut-off value) was significantly associated with elevated overall survival (P < 0.001). All independent factors for survival were selected into the nomogram. The calibration plot for the probability of survival showed good agreement between prediction by nomogram and actual observation.
This study highlighted that reduction of serum LDL-C level was an independent risk factor for the survival in patients with HBV-related ACLF, and the nomogram based on serum LDL-C was an accurate and practical model for predicting the 3-month mortality in patients with this disease.
慢加急性肝衰竭（ACLF）是一种具有高短期死亡率的临床综合征。根据预后对患者进行分层以决定管理策略非常重要。本研究旨在制定和验证一种基于血脂蛋白的列线图模型，以预测乙型肝炎病毒（HBV）相关 ACLF 患者的 3 个月死亡率。
前瞻性收集 2013 年 6 月 1 日至 2015 年 2 月 1 日中山大学附属第三医院诊断为 HBV 相关 ACLF 的 393 例连续患者的数据。其中，260 例在早期收集的患者组成列线图开发的训练队列，而此后收集的 133 例患者组成列线图验证的验证队列。
多因素分析表明，低密度脂蛋白胆固醇（LDL-C）、年龄、凝血酶原时间和肌酐与 HBV 相关 ACLF 患者 3 个月死亡率独立相关。Kaplan-Meier 生存分析显示，高 LDL-C（LDL-C≥1.0mmol/L，截断值）与总生存率升高显著相关（P<0.001）。所有生存的独立因素均被选入列线图。预测生存概率的校准图显示列线图预测与实际观察之间具有良好的一致性。
本研究强调，血清 LDL-C 水平降低是 HBV 相关 ACLF 患者生存的独立危险因素，基于血清 LDL-C 的列线图是预测该疾病患者 3 个月死亡率的准确实用模型。
