Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, No. 1838 North Guangzhou Avenue, Guangzhou 510515, China.
Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, China.
Clin Res Hepatol Gastroenterol. 2021 Mar;45(2):101482. doi: 10.1016/j.clinre.2020.06.008. Epub 2020 Jun 27.
The prognosis of hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is extremely poor due to multiple organ dysfunction.
To investigate the prognostic risk factors and create a 90-day prognostic predictive model for the patients with HBV-ACLF.
Demographic information, clinical examination, and laboratory test results of the enrolled patients were collected to study the prognostic risk factors. Univariate and multivariate analysis and stepwise Logistic regression were performed to develop the predictive model. External validation was performed to verify the model.
A total of 333 HBV-ACLF patients and 86 HBV-non-ACLF patients were included in this study. Age, alpha-fetoprotein (AFP), total bilirubin (TBIL), platelet (PLT), and international normalized ratio (INR) were found to be independent risk factors for poor outcomes of HBV-ACLF patients. The formula identified for the linear predictor (LP) of the prognosis of HBV-ACLF patients is thus: LP=-5.04-0.056×age-0.002×AFP-0.010×PLT+0.002×TBIL+0.877×INR. The area under curve (AUC) of the receiver operating characteristic curve (ROC) was 0.7835 (95% CI 0.7248-0.8423).
A predictive model with good calibration and discrimination for 90-day survival of HBV-ACLF patients, including 5 variables, namely age, AFP, PLT, TBIL, and INR was established. Platelet count was a sensitive and dynamic variable for the prognosis of HBV-ACLF.
由于多器官功能障碍，乙型肝炎病毒相关慢加急性肝衰竭（HBV-ACLF）患者的预后极差。
探讨 HBV-ACLF 患者的预后危险因素，并建立 90 天预后预测模型。
收集入组患者的人口统计学信息、临床检查和实验室检查结果，以研究预后危险因素。进行单因素和多因素分析以及逐步 Logistic 回归，以建立预测模型。进行外部验证以验证模型。
本研究共纳入 333 例 HBV-ACLF 患者和 86 例 HBV 非 ACLF 患者。年龄、甲胎蛋白（AFP）、总胆红素（TBIL）、血小板（PLT）和国际标准化比值（INR）是 HBV-ACLF 患者不良预后的独立危险因素。因此，HBV-ACLF 患者预后的线性预测因子（LP）公式为：LP=-5.04-0.056×年龄-0.002×AFP-0.010×PLT+0.002×TBIL+0.877×INR。ROC 曲线下面积（AUC）为 0.7835（95%CI 0.7248-0.8423）。
建立了一个包含 5 个变量（年龄、AFP、PLT、TBIL 和 INR）的预测模型，对 HBV-ACLF 患者 90 天生存率具有良好的校准和区分能力。血小板计数是预测 HBV-ACLF 预后的敏感和动态变量。
