Cheng Ran, Tan Ning, Kang Qian, Luo Hao, Chen Hongyu, Pan Jiali, Han Yifan, Yang Yuqing, Xu Xiaoyuan
Department of Infectious Diseases, Peking University First Hospital, 8 Xishiku Street, Beijing, 100034, China.
BMC Gastroenterol. 2020 Nov 16;20(1):381. doi: 10.1186/s12876-020-01522-6.
Lipid profiles are declined in patients with viral liver cirrhosis and correlated with severity of liver disease. Hepatitis B virus (HBV) is the leading cause of liver cirrhosis in China. Our primary aim was to investigate whether serum lipids and lipoproteins associate with survival in patients with HBV-related cirrhosis and acute gastrointestinal bleeding, and develop a 6-week mortality risk score that incorporates it.
From January 2008 to December 2015, consecutive cirrhotic patients with acute gastrointestinal bleeding admitted to our hospital were evaluated and randomly divided into the derivation (n = 629) and validation (n = 314) cohorts. A logistic regression model was established to confirm the association between lipoprotein cholesterol and mortality. Accuracy to predict mortality were assessed by area under the receiver operating characteristic curves (AUROCs) and compared using the Hanley and McNeil test.
Among study subjects, the 6-week mortality rate was 10.6%. High-density lipoprotein cholesterol (HDL-C) level was found to correlate most strongly with prognostic scores. On ROC analysis, HDL-C showed excellent diagnostic accuracy for 6-week mortality. Logistic regression analysis provided a simple algorithm based on the combined use of 4 variables (total bilirubin (TBIL), HDL-C, International normalized ratio, and hemoglobin), allowing accurate discrimination of 3 distinct prognostic subgroups with 1.7% (low risk), 12.3% (intermediate risk), and 56.9% (high risk) mortality. Its accuracy was significantly better than that of Child-Pugh, model of end-stage liver disease, albumin-bilirubin score, D'Amico model, Augustin model, AIMS65 score and Glasgow-Blatchford score. Baseline HDL-C values ≤ 0.54 mmol/L were associated with markedly lower 6-week survival. Comparable results were found in the validation set.
HDL-C is a potential indicator for the prognosis of patients with cirrhosis and acute gastrointestinal bleeding. The new algorithm based on HDL-C allowed an accurate predictive assessment of 6-week mortality after bleeding attack.
病毒性肝硬化患者的血脂水平下降，且与肝病严重程度相关。乙型肝炎病毒（HBV）是中国肝硬化的主要病因。我们的主要目的是研究血清脂质和脂蛋白是否与HBV相关肝硬化及急性胃肠道出血患者的生存情况相关，并制定一个纳入该指标的6周死亡率风险评分。
2008年1月至2015年12月，对我院收治的连续性急性胃肠道出血的肝硬化患者进行评估，并随机分为推导队列（n = 629）和验证队列（n = 314）。建立逻辑回归模型以确认脂蛋白胆固醇与死亡率之间的关联。通过受试者操作特征曲线下面积（AUROCs）评估预测死亡率的准确性，并使用Hanley和McNeil检验进行比较。
在研究对象中，6周死亡率为10.6%。发现高密度脂蛋白胆固醇（HDL-C）水平与预后评分的相关性最强。在ROC分析中，HDL-C对6周死亡率显示出优异的诊断准确性。逻辑回归分析提供了一种基于4个变量（总胆红素（TBIL）、HDL-C、国际标准化比值和血红蛋白）联合使用的简单算法，能够准确区分3个不同的预后亚组，死亡率分别为1.7%（低风险）、12.3%（中度风险）和56.9%（高风险）。其准确性明显优于Child-Pugh评分、终末期肝病模型、白蛋白-胆红素评分、D'Amico模型、Augustin模型、AIMS65评分和Glasgow-Blatchford评分。基线HDL-C值≤0.54 mmol/L与显著较低的6周生存率相关。在验证集中发现了类似结果。
HDL-C是肝硬化合并急性胃肠道出血患者预后的潜在指标。基于HDL-C的新算法能够对出血发作后6周的死亡率进行准确的预测评估。
