Center of Infectious Diseases, West China Hospital of Sichuan University, No.37 GuoXue Xiang, Wuhou District, Chengdu, 610041, China.
Sci Rep. 2021 Jan 14;11(1):1469. doi: 10.1038/s41598-021-81019-8.
Artificial liver support system (ALSS) therapy is widely used in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). We aimed to develop a predictive score to identify the subgroups who may benefit from plasma exchange (PE)-centered ALSS therapy. A total of 601 patients were retrospectively enrolled and randomly divided into a derivation cohort of 303 patients and a validation cohort of 298 patients for logistic regression analysis, respectively. Five baseline variables, including liver cirrhosis, total bilirubin, international normalized ratio of prothrombin time, infection and hepatic encephalopathy, were found independently associated with 3-month mortality. A predictive PALS model and the simplified PALS score were developed. The predicative value of PALS score (AUROC = 0.818) to 3-month prognosis was as capable as PALS model (AUROC = 0.839), R score (AUROC = 0.824) and Yue-Meng' score (AUROC = 0.810) (all p > 0.05), and superior to CART model (AUROC = 0.760) and MELD score (AUROC = 0.765) (all p < 0.05). The PALS score had significant linear correlation with 3-month mortality (R = 0.970, p = 0.000). PALS score of 0-2 had both sensitivity and negative predictive value of > 90% for 3-month mortality, while PALS score of 6-9 had both specificity and positive predictive value of > 90%. Patients with PALS score of 3-5 who received 3-5 sessions of ALSS therapy had much lower 3-month mortality than those who received 1-2 sessions (32.8% vs. 59.2%, p < 0.05). The more severe patients with PALS score of 6-9 could still benefit from ≥ 6 sessions of ALSS therapy compared to ≤ 2 sessions (63.6% vs. 97.0%, p < 0.05). The PALS score could predict prognosis reliably and conveniently. It could identify the subgroups who could benefit from PE-centered ALSS therapy, and suggest the reasonable sessions.Trial registration: Chinese Clinical Trial Registry, ChiCTR2000032055. Registered 19th April 2020, http://www.chictr.org.cn/showproj.aspx?proj=52471 .
人工肝支持系统（ALSS）治疗广泛应用于乙型肝炎病毒相关慢加急性肝衰竭（HBV-ACLF）患者。我们旨在开发一种预测评分，以确定可能从以血浆置换（PE）为中心的 ALSS 治疗中获益的亚组。总共回顾性纳入 601 名患者，并分别将其随机分为 303 名患者的推导队列和 298 名患者的验证队列，进行逻辑回归分析。发现 5 个基线变量（包括肝硬化、总胆红素、国际标准化比值的凝血酶原时间、感染和肝性脑病）与 3 个月死亡率独立相关。开发了预测 PALS 模型和简化 PALS 评分。PALS 评分（AUROC=0.818）对 3 个月预后的预测价值与 PALS 模型（AUROC=0.839）、R 评分（AUROC=0.824）和 Yue-Meng'评分（AUROC=0.810）相当（均 p>0.05），优于 CART 模型（AUROC=0.760）和 MELD 评分（AUROC=0.765）（均 p<0.05）。PALS 评分与 3 个月死亡率呈显著线性相关（R=0.970，p=0.000）。PALS 评分 0-2 分对 3 个月死亡率的敏感性和阴性预测值均>90%，而 PALS 评分 6-9 分对 3 个月死亡率的特异性和阳性预测值均>90%。接受 3-5 次 ALSS 治疗的 PALS 评分 3-5 分的患者的 3 个月死亡率明显低于接受 1-2 次 ALSS 治疗的患者（32.8%比 59.2%，p<0.05）。PALS 评分 6-9 分的更严重患者仍可从≥6 次 ALSS 治疗中获益，优于≤2 次（63.6%比 97.0%，p<0.05）。PALS 评分可可靠且方便地预测预后。它可以识别可能从以 PE 为中心的 ALSS 治疗中获益的亚组，并建议合理的治疗次数。试验注册：中国临床试验注册中心，ChiCTR2000032055。于 2020 年 4 月 19 日注册，http://www.chictr.org.cn/showproj.aspx?proj=52471。
