Department of Hepatology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
Hepatology Institute of Shandong University, Jinan, Shandong, China.
Eur J Med Res. 2022 Nov 14;27(1):248. doi: 10.1186/s40001-022-00891-w.
Early prediction for short-term prognosis is essential for the management of hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF). In this study, we aim to establish a noninvasive model for predicting the 90-day mortality in patients with HBV-ACLF received glucocorticoid therapy.
Two hundred and eighty patients with HBV-ACLF were enrolled from July 2010 to June 2022. All patients received routine medicine treatment and 204 of them received additional glucocorticoid treatment. Then, the patients who received glucocorticoid treatment were randomly divided into a training cohort and a validation cohort. An early prediction model for 90-day mortality of HBV-ACLF was established in the training cohort and then validated in the validation cohort.
HBV-ACLF patients received glucocorticoid treatment showed significantly better survival that those not (P < 0.01). In the training cohort, a noninvasive model was generated with hepatic encephalopathy grade, INR, total bilirubin, age and SIRS status, which was named HITAS score. It showed significantly better predictive value for 90-day mortality of HBV-ACLF than MELD score and Child-Turcotte-Pugh score in both the training cohort and validation cohort. Using the Kaplan-Meier analysis with cutoff points of 2.5 and 3.47, the HITAS score can classify HBV-ACLF patients into different groups with low, intermediate and high risk of death after glucocorticoid therapy.
We proposed a HITAS score, which was an early prediction model for the prognosis of HBV-ACLF. It might be used to identify HBV-ACLF patients with favorable responses to glucocorticoid treatment.
早期预测短期预后对于乙型肝炎病毒（HBV）相关慢加急性肝衰竭（ACLF）的管理至关重要。本研究旨在建立一种非侵入性模型，用于预测接受糖皮质激素治疗的 HBV-ACLF 患者 90 天死亡率。
2010 年 7 月至 2022 年 6 月期间共纳入 280 例 HBV-ACLF 患者。所有患者均接受常规药物治疗，其中 204 例接受糖皮质激素治疗。然后，接受糖皮质激素治疗的患者被随机分为训练队列和验证队列。在训练队列中建立了一个用于预测 HBV-ACLF 90 天死亡率的早期预测模型，然后在验证队列中进行验证。
接受糖皮质激素治疗的 HBV-ACLF 患者的生存率明显高于未接受治疗的患者（P<0.01）。在训练队列中，构建了一个由肝性脑病分级、INR、总胆红素、年龄和 SIRS 状态组成的非侵入性模型，命名为 HITAS 评分。该评分在训练队列和验证队列中均显示出比 MELD 评分和 Child-Turcotte-Pugh 评分更好的预测 90 天死亡率的能力。使用 Kaplan-Meier 分析，以 2.5 和 3.47 为截断点，HITAS 评分可将 HBV-ACLF 患者分为糖皮质激素治疗后死亡风险低、中、高的不同组别。
我们提出了一个 HITAS 评分，这是一个预测 HBV-ACLF 预后的早期预测模型。它可能用于识别对糖皮质激素治疗有良好反应的 HBV-ACLF 患者。
