Department of Infectious Diseases, Hunan Key Laboratory of Viral Hepatitis, Xiangya Hospital, Central South University, Changsha, China.
Department of Gastroenterology, School of Medicine, Ren Ji Hospital, Shanghai Jiao Tong University, Shanghai, China.
Age Ageing. 2023 Jan 8;52(1). doi: 10.1093/ageing/afac313.
the incidence of acute-on-chronic liver disease (AoCLD) is increasing.
to investigate the clinical features and risk factors of AoCLD and construct an effective prognostic nomogram model for older patients with AoCLD.
data from 3,970 patients included in the CATCH-LIFE study were used, including 2,600 and 1,370 patients in the training and validation sets, respectively. Multivariate Cox regression analyses were performed to identify predictive risk factors in older individuals, and an easy-to-use nomogram was established. Performance was assessed using area under the curve, calibration plots and decision curve analysis (DCA).
of the 3,949 patients with AoCLD, 809 were older with a higher proportion of autoimmune-related abnormalities, hepatitis C viral infection and schistosomiasis. In the older patient group, the incidence of cirrhosis, hepatic encephalopathy (HE), infection, ascites and gastrointestinal bleeding; neutrophil-to-lymphocyte ratio (NLR), aspartate-to-alanine transaminase ratio (AST/ALT), creatinine and blood urea nitrogen levels were higher, whereas incidence of acute-on-chronic liver failure, white blood cell, platelet and haemoglobin levels; albumin, total bilirubin (TB), AST and ALT levels; international normalised ratio (INR), estimated glomerular filtration rate and blood potassium levels were lower than in the younger group. The final nomogram was developed based on the multivariate Cox analysis in training cohort using six risk factors: ascites, HE grades, NLR, TB, INR and AST/ALT. Liver transplantation-free mortality predictions were comparable between the training and validation sets. DCA showed higher net benefit for the nomograph than the treat-all or treat-none strategies, with wider threshold probabilities ranges.
our analysis will assist clinical predictions and prognoses in older patients with AoCLD.
急性肝衰竭合并慢性肝病（AoCLD）的发病率正在上升。
探讨 AoCLD 的临床特征和危险因素，并构建老年 AoCLD 患者有效的预后列线图模型。
使用 CATCH-LIFE 研究中纳入的 3970 例患者的数据，分别为训练集和验证集 2600 例和 1370 例。进行多变量 Cox 回归分析以确定老年人的预测风险因素，并建立易于使用的列线图。使用曲线下面积、校准图和决策曲线分析（DCA）评估性能。
在 3949 例 AoCLD 患者中，809 例年龄较大，自身免疫相关异常、丙型肝炎病毒感染和血吸虫病的比例较高。在老年患者组中，肝硬化、肝性脑病（HE）、感染、腹水和胃肠道出血的发生率、中性粒细胞与淋巴细胞比值（NLR）、天冬氨酸转氨酶/丙氨酸转氨酶比值（AST/ALT）、肌酐和血尿素氮水平较高，而急性肝衰竭、白细胞、血小板和血红蛋白水平、白蛋白、总胆红素（TB）、AST 和 ALT 水平、国际标准化比值（INR）、估计肾小球滤过率和血钾水平较低。最终的列线图是基于训练队列的多变量 Cox 分析，使用 6 个风险因素：腹水、HE 分级、NLR、TB、INR 和 AST/ALT 建立的。肝移植无死亡率预测在训练集和验证集之间具有可比性。DCA 表明，与“治疗所有”或“不治疗任何”策略相比，列线图具有更高的净获益，且阈值概率范围更广。
我们的分析将有助于对老年 AoCLD 患者进行临床预测和预后评估。
