Li Xue, Li Hao, Zhu Yucui, Xu Huaqian, Tang Shanhong
Department of Gastroenterology, The General Hospital of Western Theater Command, Chengdu 610083, China.
Clinic, The General Hospital of Western Theater Command, Chengdu 610083, China.
J Clin Med. 2023 Jan 20;12(3):851. doi: 10.3390/jcm12030851.
The platelet (PLT) value in hepatitis B-related acute-on-chronic liver failure (HBV-ACLF) is not sufficiently understood. The present study aimed to evaluate the prognostic effect of PLT on the prediction of HBV-ACLF outcomes after plasma exchange (PE).
HBV-ACLF patients treated with PE between January 2017 and August 2021 were followed up for at least 6 months. Cox regression was performed to develop the predictive model, and the model's performance was analyzed using the receiver operating characteristic curve (ROC).
A total of 170 patients were included. The overall survival rate within 180 days was 75.88%. Age, PLT, total bilirubin (TBil), and the iMELD scores were independent risk factors affecting the prognosis of HBV-ACLF patients after PE. According to the Cox regression results, the new model was calculated: R = 0.142 × iMELD-0.009 × PLT. The area under the curve (AUC) of the receiver operating characteristic curve (ROC) was 0.758 (95% CI 0.678-0.838), and patients with lower PLT-iMELD scores (<4.50) had a better prognosis ( < 0.001).
PLT is a valuable prognostic biomarker for HBV-ACLF patients after PE. The modified iMELD model incorporating PLT has a better sensitivity and efficacy in predicting the prognosis of patients.
乙型肝炎相关慢加急性肝衰竭（HBV-ACLF）患者的血小板（PLT）值尚未得到充分了解。本研究旨在评估PLT对血浆置换（PE）后HBV-ACLF患者预后预测的影响。
对2017年1月至2021年8月期间接受PE治疗的HBV-ACLF患者进行至少6个月的随访。采用Cox回归建立预测模型，并使用受试者工作特征曲线（ROC）分析模型性能。
共纳入170例患者。180天内的总生存率为75.88%。年龄、PLT、总胆红素（TBil）和iMELD评分是影响PE后HBV-ACLF患者预后的独立危险因素。根据Cox回归结果，计算出新模型：R = 0.142×iMELD - 0.009×PLT。受试者工作特征曲线（ROC）的曲线下面积（AUC）为0.758（95%CI 0.678 - 0.838），PLT-iMELD评分较低（<4.50）的患者预后较好（<0.001）。
PLT是PE后HBV-ACLF患者有价值的预后生物标志物。纳入PLT的改良iMELD模型在预测患者预后方面具有更好的敏感性和有效性。
