Peking University 302 Clinical Medical School, Beijing, China.
Senior Department of Infectious Diseases, Fifth Medical Center of Chinese, PLA General Hospital, National Clinical Research Center for Infectious Diseases, 100 Xisihuan Road, Fengtai District, Beijing, 100039, China.
Hepatol Int. 2022 Oct;16(5):1116-1126. doi: 10.1007/s12072-022-10302-1. Epub 2022 Feb 28.
Hepatitis E virus-related acute liver failure (HEV-ALF) rapidly worsens and has a high mortality. However, no simple and specific parameters for predicting short-term mortality are available.
A derivation cohort including 97 patients with HEV-ALF and another validation cohort were enrolled. Laboratory and clinical parameters were recorded. Platelet count, model for end-stage liver disease (MELD), and King's College criteria (KCC) were separately used for predicting mortality, and the levels of cytokines associated with systemic inflammation, platelet production, and platelet activation were measured.
Platelet counts were significantly lower in patients with HEV-ALF, and nonsurvivors had lower platelet counts than survivors (p < 0.001). Platelet count was an independent risk factor for predicting 28- and 90-day mortality in patients with HEV-ALF. The AUROC of the baseline platelet count (cutoff, 131 × 10/L) for 28- and 90-day mortality was 0.786 and 0.764, respectively, which was superior to KCC score (p < 0.05) and comparable to MELD score. Furthermore, the platelet counts at 3 and 7 days after ALF diagnosis had similar predictive power for 28- and 90-day mortality. The value of platelet count was also confirmed in the validation cohort. Moreover, platelet-associated cytokines, including thrombopoietin, platelet factor 4, and P-selectin, were increased in patients with HEV-ALF.
Decreased platelet count is a simple and reliable indicator for predicting 28- and 90-day mortality in patients with HEV-ALF. Overactivation of platelets is an important risk for platelet counts decrease, and treatment aiming at platelet count recovery may be considered.
戊型肝炎病毒相关的急性肝衰竭（HEV-ALF）迅速恶化，死亡率高。然而，目前尚无简单、特异的参数来预测短期死亡率。
本研究纳入了 97 例 HEV-ALF 患者的队列（为推导队列）和另一验证队列。记录了实验室和临床参数。血小板计数、终末期肝病模型（MELD）和 King 学院标准（KCC）分别用于预测死亡率，并测量了与全身炎症、血小板生成和血小板激活相关的细胞因子水平。
HEV-ALF 患者的血小板计数显著降低，且存活者的血小板计数高于非存活者（p<0.001）。血小板计数是预测 HEV-ALF 患者 28 天和 90 天死亡率的独立危险因素。基线血小板计数（截断值，131×10/L）预测 28 天和 90 天死亡率的 AUROC 分别为 0.786 和 0.764，优于 KCC 评分（p<0.05），与 MELD 评分相当。此外，肝衰竭诊断后 3 天和 7 天的血小板计数对 28 天和 90 天死亡率也有相似的预测能力。该血小板计数值在验证队列中也得到了验证。此外，血小板相关细胞因子，包括血小板生成素、血小板因子 4 和 P-选择素，在 HEV-ALF 患者中增加。
血小板计数降低是预测 HEV-ALF 患者 28 天和 90 天死亡率的简单、可靠指标。血小板过度激活是血小板计数降低的重要危险因素，可能需要考虑针对血小板计数恢复的治疗。
