胶原比例面积可预测酒精性肝炎患者的长期死亡率。
Collagen proportionate area predicts long-term mortality in patients with alcoholic hepatitis.
作者信息
Israelsen Mads, Misas Marta Guerrero, Koutsoumourakis Anastasios, Hall Andrew, Covelli Claudia, Buzzetti Elena, Prat Laura Iogna, Roccarina Davide, Luong Tu Vinh, Quaglia Alberto, Pinzani Massimo, Tsochatzis Emmanuel A
机构信息
UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK; Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark.
UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK.
出版信息
Dig Liver Dis. 2022 May;54(5):663-668. doi: 10.1016/j.dld.2021.08.021. Epub 2021 Sep 20.
BACKGROUND AND AIMS
There are several short-term prognostic scores for alcoholic hepatitis (AH) that combine demographical and biochemical parameters. The extent of liver fibrosis may also be relevant to the prognosis of AH with potential added value. We evaluated collagen proportionate area (CPA) as a predictor of short and long-term mortality in AH.
METHODS
We retrospectively included patients with biopsy-verified AH. Clinical, laboratory and outcome data were collected. CPA and five AH scores were calculated: Maddrey's DF, MELD, GAHS, ABIC, and the Lille Model. Predictors of short and long-term all-cause mortality were assessed using Cox regression analysis.
RESULTS
We included 140 patients with AH. In total, 67 (48%) patients died after a median follow-up of 66 (IQR 102) months, with 17 (12%) dying within the first 90-days. CPA was not a predictor of 90-days mortality and had no additional value to the prognostic AH scores on short-term mortality. However, CPA predicted long-term mortality independently of prognostic AH scores. Importantly, CPA and abstinence from alcohol were independent predictors of long-term mortality in patients alive 90 days after the biopsy.
CONCLUSION
CPA predicts long-term mortality in patients with AH independently of abstinence from alcohol but has no prognostic value on short-term mortality.
背景与目的
有几种用于酒精性肝炎（AH）的短期预后评分系统，它们综合了人口统计学和生化参数。肝纤维化程度可能也与AH的预后相关，且可能具有附加价值。我们评估了胶原比例面积（CPA）作为AH短期和长期死亡率的预测指标。
方法
我们回顾性纳入了经活检证实为AH的患者。收集了临床、实验室和结局数据。计算了CPA以及五种AH评分：Maddrey判别函数（DF）、终末期肝病模型（MELD）、格拉斯哥酒精性肝炎评分（GAHS）、澳大利亚生物标志物整合协作组评分（ABIC）和里尔模型。使用Cox回归分析评估短期和长期全因死亡率的预测指标。
结果
我们纳入了140例AH患者。中位随访66（四分位间距102）个月后，共有67例（48%）患者死亡，其中17例（12%）在最初90天内死亡。CPA不是90天死亡率的预测指标，在短期死亡率方面对预后AH评分没有附加价值。然而，CPA独立于预后AH评分预测长期死亡率。重要的是，CPA和戒酒是活检后存活90天患者长期死亡率的独立预测指标。
结论
CPA独立于戒酒可预测AH患者的长期死亡率，但对短期死亡率没有预后价值。
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