Tang Y H, Zhang X X, Zhang S Y, Cui L Y, Wang Y Q, Xue N N, Li L, Zhao D D, Nan Y M
Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical University, Hebei Key Laboratory of Mechanism of Liver Fibrosis in Chronic Liver Disease, Shijiazhuang 050051, China.
Zhonghua Gan Zang Bing Za Zhi. 2023 Jan 20;31(1):84-89. doi: 10.3760/cma.j.cn501113-20211110-00543.
To identify the predisposing factors, clinical characteristics, and risk factors of disease progression to establish a novel predictive survival model and evaluate its application value for hepatitis B virus-related acute-on-chronic liver failure. 153 cases of HBV-ACLF were selected according to the guidelines for the diagnosis and treatment of liver failure (2018 edition) of the Chinese Medical Association Hepatology Branch. Predisposing factors, the basic liver disease stage, therapeutic drugs, clinical characteristics, and factors affecting survival status were analyzed. Cox proportional hazards regression analysis was used to screen prognostic factors and establish a novel predictive survival model. The receiver operating characteristic curve (ROC) was used to evaluate predictive value with the Model for End-Stage Liver Disease (MELD) and the Chronic Liver Failure Consortium Acute-on-Chronic Liver Failure score (CLIF-C ACLF). 80.39% (123/153) based on hepatitis B cirrhosis had developed ACLF. HBV-ACLF's main inducing factors were the discontinuation of nucleos(t)ide analogues (NAs) and the application of hepatotoxic drugs, including Chinese patent medicine/Chinese herbal medicine, non-steroidal anti-inflammatory drugs, anti-tuberculosis drugs, central nervous system drugs, anti-tumor drugs, etc. 34.64% of cases had an unknown inducement. The most common clinical symptoms at onset were progressive jaundice, poor appetite, and fatigue. The short-term mortality rate was significantly higher in patients complicated with hepatic encephalopathy, upper gastrointestinal hemorrhage, hepatorenal syndrome, and infection ( < 0.05). Lactate dehydrogenase, albumin, the international normalized ratio, the neutrophil-to-lymphocyte ratio, hepatic encephalopathy, and upper gastrointestinal bleeding were the independent predictors for the survival status of patients. The LAINeu model was established. The area under the curve for evaluating the survival of HBV-ACLF was 0.886, which was significantly higher than the MELD and CLIF-C ACLF scores ( < 0.05), and the prognosis was worse when the LAINeu score ≥ -3.75. Discontinuation of NAs and the application of hepatotoxic drugs are common predisposing factors for HBV-ACLF. Hepatic decompensation-related complications and infection accelerate the disease's progression. The LAINeu model can predict patient survival conditions more accurately.
为识别疾病进展的易感因素、临床特征和危险因素，建立新的预测生存模型，并评估其对乙型肝炎病毒相关慢加急性肝衰竭的应用价值。根据中华医学会肝病学分会《肝衰竭诊治指南（2018年版）》选取153例HBV-ACLF患者。分析易感因素、基础肝病分期、治疗药物、临床特征及影响生存状态的因素。采用Cox比例风险回归分析筛选预后因素并建立新的预测生存模型。采用受试者工作特征曲线（ROC），以终末期肝病模型（MELD）和慢性肝衰竭协作组慢加急性肝衰竭评分（CLIF-C ACLF）评估预测价值。80.39%（123/153）的患者基于乙型肝炎肝硬化发展为ACLF。HBV-ACLF的主要诱发因素是核苷（酸）类似物（NAs）停药及肝毒性药物的应用，包括中成药/中草药、非甾体抗炎药、抗结核药、中枢神经系统药物、抗肿瘤药物等。34.64%的病例诱因不明。发病时最常见的临床症状为进行性黄疸、食欲减退和乏力。合并肝性脑病、上消化道出血、肝肾综合征和感染的患者短期死亡率显著更高（<0.05）。乳酸脱氢酶、白蛋白、国际标准化比值、中性粒细胞与淋巴细胞比值、肝性脑病和上消化道出血是患者生存状态的独立预测因素。建立了LAINeu模型。评估HBV-ACLF生存情况的曲线下面积为0.886，显著高于MELD和CLIF-C ACLF评分（<0.05），且当LAINeu评分≥-3.75时预后较差。NAs停药及肝毒性药物的应用是HBV-ACLF常见的易感因素。肝失代偿相关并发症和感染加速疾病进展。LAINeu模型能更准确地预测患者生存情况。
