布加综合征合并急性肝衰竭及预测病死率模型。

Acute liver failure in Budd-Chiari syndrome and a model to predict mortality.

机构信息

Institute of Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, MD, USA.

Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.

出版信息

Hepatol Int. 2021 Feb;15(1):146-154. doi: 10.1007/s12072-020-10115-0. Epub 2021 Jan 2.

DOI:10.1007/s12072-020-10115-0

PMID:33387301

Abstract

BACKGROUND AND OBJECTIVE

Acute liver failure (ALF) occurs in approximately 1-2% of patients with Budd-Chiari syndrome (BCS). The primary objective of our study was to study the outcome of patients with BCS-ALF using the National Inpatient Sample (NIS) database and develop a mortality prediction model.

DESIGN

We identified all adult patients with BCS, with and without ALF, using ICD-9 or ICD-10. Using clinical variables, we identified risk factors for in-hospital mortality and developed a prediction model using logistic regression analysis. The model was built and validated in a training and validation datasets.

RESULTS

Between 2008 and 2017, of the estimated total of 5,306 (weighted sample size 26,110) BCS discharges, 325 (6.1%) patients (weighted sample size 1,598) presented with ALF. Of 325 BCS-ALF patients, 114 (34.7%, weighted n = 554) died and in contrast only 267 of 4,981 (5%, weighted n = 1310) without ALF died during the hospitalization. The independent risk factors that predicted mortality were age 50 years or older, acute respiratory failure, spontaneous bacterial peritonitis, sepsis and cancers. The prediction model that incorporated these risk factors had an area under the receiver operating characteristic curve (AUROC) of 0.85 (95% CI 0.80-0.90) for training data and 0.80 (95% CI 0.71-0.89) for validation data. The predicted mortality risk with low (score < 6), intermediate (score 6-16), and high risk (score ≥ 17) scores were 8%, 37% and 71%, respectively.

CONCLUSION

ALF due to BCS is associated with a very high in-hospital mortality that could be predicted with reasonable accuracy.

摘要

背景与目的

急性肝衰竭（ALF）约占布加氏综合征（BCS）患者的 1-2%。本研究的主要目的是使用国家住院患者样本（NIS）数据库研究 BCS-ALF 患者的预后，并建立一个死亡率预测模型。

设计

我们使用 ICD-9 或 ICD-10 识别所有伴有和不伴有 ALF 的成年 BCS 患者。使用临床变量，我们确定了院内死亡率的危险因素，并使用逻辑回归分析建立了一个预测模型。该模型在训练和验证数据集进行了构建和验证。

结果

在 2008 年至 2017 年间，估计的 5306 例（加权样本量 26110 例）BCS 出院患者中，有 325 例（6.1%）（加权样本量 1598 例）出现 ALF。在 325 例 BCS-ALF 患者中，有 114 例（34.7%，加权 n=554）死亡，而在 4981 例无 ALF 患者中，仅有 267 例（5%，加权 n=1310）在住院期间死亡。预测死亡率的独立危险因素为 50 岁或以上、急性呼吸衰竭、自发性细菌性腹膜炎、败血症和癌症。纳入这些危险因素的预测模型在训练数据中的接收者操作特征曲线（AUROC）下面积为 0.85（95%CI 0.80-0.90），在验证数据中的 AUROC 下面积为 0.80（95%CI 0.71-0.89）。低（评分<6）、中（评分 6-16）和高（评分≥17）风险评分的预测死亡率分别为 8%、37%和 71%。