Zhao Jie, Li Li, Li Xiuhui, Guo Liying, Li Qiuwei, Miao Jing, Gou Chunyan, Yang Huasheng, Luo Xiaolan, Jia Jianwei
Department of Special Ward, Tianjin Second People's Hospital, Tianjin 300192, China.
Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2020 Aug;32(8):988-993. doi: 10.3760/cma.j.cn121430-20200102-00075.
To establish a predictive model and investigate its value in evaluating short-term prognosis of patients with hepatitis B virus related acute-on-chronic liver failure (HBV-ACLF).
Patients with HBV-ACLF admitted to Tianjin Second People's Hospital and Beijing Youan Hospital, Capital Medical University from May 2015 to October 2018 were enrolled. The data of gender, age, laboratory markers at admission, model for end-stage liver disease (MELD) score and clinical complications were collected for analysis. According to the prognosis on 12-week, patients were divided into survival group and death group. Univariate analysis and binary Logistic regression analysis were used to test the risk factors for short-term prognosis of the patients with HBV-ACLF, and a prediction model was established. The accuracy of each index and the established model were verified by the receiver operating characteristic (ROC) curve.
A total of 148 patients with HBV-ACLF were enrolled in the study, 91 cases survived while 57 cases died during the 12-week period. The age, total bilirubin (TBIL), neutrophil percentage (NEUT%), hepatitis B surface antigen (HBsAg), MELD score of death group were higher than those of survival group [age (years old): 50.00 (44.50, 55.00) vs. 43.00 (34.00, 53.00), TBIL (μmol/L): 310.30 (240.70, 405.70) vs. 266.40 (184.20, 360.20), NEUT%: (74.52±13.05)% vs. (66.64±12.35)%, lgHBsAg (kU/L): 3.72 (3.29, 3.92) vs. 2.97 (2.49, 3.78), MELD score: 24.27 (19.71, 27.40) vs. 21.88 (18.83, 24.38), all P < 0.05], while albumin (ALB), total cholesterol (CHO), prothrombin activity (PTA) and alpha-fetoprotein (AFP) were lower than those of survival group [ALB (g/L): 29.80 (27.05, 31.05) vs. 30.80 (28.00, 33.90), CHO (mmol/L): 1.98 (1.50, 2.38) vs. 2.49 (2.05, 3.01), PTA: (30.37±7.09)% vs. (32.94±6.03)%, AFP (μg/L): 21.54 (9.28, 51.54) vs. 66.16 (24.50, 152.80), all P < 0.05]. Logistic regression analysis showed that NEUT%, HBsAg and AFP were independent risk factors for short-term prognosis of patients with HBV-ACLF [odds ratio (OR) was 77.843, 1.439, 0.995, respectively, all P < 0.05]. According to the results of regression analysis, the NHA-ACLF model (NEUT%+HBsAg+AFP) was established. The formula was logit (NHA-ACLF) = -5.441+5.688×NEUT%+0.430×lgHBsAg-0.005×AFP. The area under the ROC curve (AUC) of the NHA-ACLF model for pred HBV-ACLF patients was 0.790, which was better than NEUT% (AUC = 0.696), lgHBsAg (AUC = 0.670), AFP (AUC = 0.703) and MELD score (AUC = 0.640). When the cut-off value of NHA-ACLF model score was 0.459, the sensitivity was 73.7%, and the specificity was 79.1%.
NEUT%, HBsAg and AFP are independent predictive indicator for short-term prognosis in patients with HBV-ACLF. Compared with MELD score, the risk assessment model NHA-ACLF has a greater value in predicting the short-term prognosis of patients with HBV-ACLF.
建立预测模型并探讨其在评估乙型肝炎病毒相关慢加急性肝衰竭（HBV-ACLF）患者短期预后中的价值。
纳入2015年5月至2018年10月在天津市第二人民医院和首都医科大学附属北京佑安医院收治的HBV-ACLF患者。收集患者的性别、年龄、入院时实验室指标、终末期肝病模型（MELD）评分及临床并发症等资料进行分析。根据12周时的预后情况，将患者分为生存组和死亡组。采用单因素分析和二元Logistic回归分析检验HBV-ACLF患者短期预后的危险因素，并建立预测模型。通过受试者工作特征（ROC）曲线验证各指标及所建立模型的准确性。
共纳入148例HBV-ACLF患者，12周内91例存活，57例死亡。死亡组患者的年龄、总胆红素（TBIL）、中性粒细胞百分比（NEUT%）、乙型肝炎表面抗原（HBsAg）、MELD评分高于生存组[年龄（岁）：50.00（44.50，55.00）比43.00（34.00，53.00），TBIL（μmol/L）：310.30（240.70，405.70）比266.40（184.20，360.20），NEUT%：（74.52±13.05）%比（66.64±12.35）%，lgHBsAg（kU/L）：3.72（3.29，3.92）比2.97（2.49，3.78），MELD评分：24.27（19.71，27.40）比21.88（18.83，24.38），均P<0.05]，而白蛋白（ALB）、总胆固醇（CHO）、凝血酶原活动度（PTA）和甲胎蛋白（AFP）低于生存组[ALB（g/L）：29.80（27.05，31.05）比30.80（28.00，33.90），CHO（mmol/L）：1.98（1.50，2.38）比2.49（2.05，3.01），PTA：（30.37±7.09）%比（32.94±6.03）%，AFP（μg/L）：21.54（9.28，51.54）比66.16（24.50，152.80），均P<0.05]。Logistic回归分析显示，NEUT%、HBsAg和AFP是HBV-ACLF患者短期预后的独立危险因素[比值比（OR）分别为77.843、1.439、0.995，均P<0.05]。根据回归分析结果，建立了NHA-ACLF模型（NEUT%+HBsAg+AFP）。公式为logit（NHA-ACLF）=-5.441+5.688×NEUT%+0.430×lgHBsAg-0.005×AFP。NHA-ACLF模型预测HBV-ACLF患者的ROC曲线下面积（AUC）为0.790，优于NEUT%（AUC=0.696）、lgHBsAg（AUC=0.670）、AFP（AUC=0.703）和MELD评分（AUC=0.640）。当NHA-ACLF模型评分的截断值为0.459时，敏感度为73.7%，特异度为79.1%。
NEUT%、HBsAg和AFP是HBV-ACLF患者短期预后的独立预测指标。与MELD评分相比，风险评估模型NHA-ACLF在预测HBV-ACLF患者短期预后方面具有更大价值。
