Xu Juan, Du Fenjing, Yang Nan, Hou Jingtao, Fan Yan, Liu Xiaojing
Department of Infection, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Ann Transl Med. 2022 Apr;10(7):406. doi: 10.21037/atm-22-461.
The prognosis for patients with chronic hepatitis B virus (HBV)-related subacute liver failure is poor. Thus, accurate prognostication would facilitate management and optimize liver allocation. This study aimed to explore the risk factors for HBV-related subacute liver failure and establish a risk model.
A total of 192 patients with HBV-related subacute liver failure treated at the First Affiliated Hospital of Xi'an Jiaotong University during January 2018 to January 2019 were selected and divided into the survival group (n=113) and the death group (n=79) based on their status within 6 months. Patient information were collected, including age, sex, body mass index, complications, hepatitis B e antigen (HBeAg), hepatic encephalopathy, hepatorenal syndrome, infections, ascites, HBV-DNA, Model for End-Stage Liver Disease (MELD), liver function tests, international normalized ratio (INR), serum creatinine and total cholesterol. Binary logistic regression was employed to identify risk factors for risk model establishment. The predictive value of the risk model was assessed with a receiver operating characteristic (ROC) curve.
Compared with the survival group, the patient age, incidence of hepatic encephalopathy and hepatorenal syndrome, infection and ascites rate, MELD score, and alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), INR, and serum creatinine levels were significantly elevated, whereas the total cholesterol level was significantly decreased in the death group (all P<0.05). Patient age [odds ratio (OR) =1.11, P=0.03], hepatic encephalopathy (OR =8.31, P=0.02), infection (OR =4.27, P=0.005), ascites (OR =4.54, P=0.006), MELD score (OR =1.39, P<0.001), INR (OR =5.89, P=0.001), and total cholesterol (OR =0.31, P=0.002) were identified as prognostic factors affecting patient mortality. Although both the MELD score and the risk model established in the present study could differentiate patient outcomes, the area under the curve (AUC) (0.94 . 0.82, P<0.001) and sensitivity (91.1% 58.2%, P<0.001) of the established risk model were significantly higher than those of the MELD score.
Patient age, hepatic encephalopathy, infection, ascites, MELD score, INR, and total cholesterol level were independent prognostic factors. The prognostic model established based on these risk factors may have favorable predictive value.
慢性乙型肝炎病毒（HBV）相关亚急性肝衰竭患者的预后较差。因此，准确的预后评估有助于管理并优化肝脏分配。本研究旨在探讨HBV相关亚急性肝衰竭的危险因素并建立风险模型。
选取2018年1月至2019年1月在西安交通大学第一附属医院接受治疗的192例HBV相关亚急性肝衰竭患者，根据其6个月内的状况分为生存组（n = 113）和死亡组（n = 79）。收集患者信息，包括年龄、性别、体重指数、并发症、乙肝e抗原（HBeAg）、肝性脑病、肝肾综合征、感染、腹水、HBV-DNA、终末期肝病模型（MELD）、肝功能检查、国际标准化比值（INR）、血清肌酐和总胆固醇。采用二元逻辑回归确定建立风险模型的危险因素。用受试者工作特征（ROC）曲线评估风险模型的预测价值。
与生存组相比，死亡组患者的年龄、肝性脑病和肝肾综合征的发生率、感染和腹水率、MELD评分以及丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、碱性磷酸酶（ALP）、INR和血清肌酐水平显著升高，而总胆固醇水平显著降低（均P<0.05）。患者年龄[比值比（OR）=1.11，P = 0.03]、肝性脑病（OR = 8.31，P = 0.02）、感染（OR = 4.27，P = 0.005）、腹水（OR = 4.54，P = 0.006）、MELD评分（OR = 1.39，P<0.001）、INR（OR = 5.89，P = 0.001）和总胆固醇（OR = 0.31，P = 0.002）被确定为影响患者死亡率的预后因素。虽然MELD评分和本研究建立的风险模型均能区分患者结局，但建立的风险模型的曲线下面积（AUC）（0.94对0.82，P<0.001）和敏感度（91.1%对58.2%，P<0.001）显著高于MELD评分。
患者年龄、肝性脑病、感染、腹水、MELD评分、INR和总胆固醇水平是独立的预后因素。基于这些危险因素建立的预后模型可能具有良好的预测价值。
