Department of Infectious Diseases, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jin-Shan District, Shanghai, 201508, China.
Department of Hepatology, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jin-Shan District, Shanghai, 201508, China.
Lipids Health Dis. 2023 Jun 24;22(1):80. doi: 10.1186/s12944-023-01826-y.
BACKGROUND/AIMS: Hepatitis E virus (HEV)-triggered acute-on-chronic liver failure (ACLF) has unacceptably high short-term mortality. However, it is unclear whether the existing predictive scoring models are applicable to evaluate the prognosis of HEV-triggered ACLF.
We screened datasets of patients with HEV-triggered ACLF from a regional tertiary hospital for infectious diseases in Shanghai, China, between January 2011 and January 2021. Clinical and laboratory parameters were recorded and compared to determine a variety of short-term mortality risk factors, which were used to develop and validate a new prognostic scoring model.
Out of 4952 HEV-infected patients, 817 patients with underlying chronic liver disease were enrolled in this study. Among these, 371 patients with HEV-triggered ACLF were identified and allocated to the training set (n = 254) and test set (n = 117). The analysis revealed that hepatic encephalopathy (HE), ascites, triacylglycerol and apolipoprotein A (apoA) were associated with 90-day mortality (P < 0.05). Based on these significant indicators, we designed and calculated a new prognostic score = 0.632 × (ascites: no, 1 point; mild to moderate, 2 points; severe, 3 points) + 0.865 × (HE: no, 1 point; grade 1-2, 2 points; grade 3-4, 3 points) - 0.413 × triacylglycerol (mmol/L) - 2.171 × apoA (g/L). Compared to four well-known prognostic models (MELD score, CTP score, CLIF-C OFs and CLIF-C ACLFs), the new scoring model is more accurate, with the highest auROCs of 0.878 and 0.896, respectively, to predict 28- and 90-day transplantation-free survival from HEV-triggered ACLF. When our model was compared to COSSH ACLF IIs, there was no significant difference. The test data also demonstrated good concordance.
This study is one of the first to address the correlation between hepatitis E and serum lipids and provides a new simple and efficient prognostic scoring model for HEV-triggered ACLF.
背景/目的：戊型肝炎病毒（HEV）引起的慢加急性肝衰竭（ACLF）具有不可接受的高短期死亡率。然而，目前尚不清楚现有的预测评分模型是否适用于评估 HEV 引起的 ACLF 的预后。
我们从中国上海一家传染病地区性三级医院筛选了 2011 年 1 月至 2021 年 1 月期间的 HEV 引起的 ACLF 患者数据集。记录临床和实验室参数，并进行比较以确定各种短期死亡风险因素，这些因素用于开发和验证新的预后评分模型。
在 4952 例 HEV 感染患者中，纳入了 817 例患有基础慢性肝病的患者。其中，371 例被诊断为 HEV 引起的 ACLF，并被分配到训练集（n=254）和测试集（n=117）。分析显示，肝性脑病（HE）、腹水、三酰甘油和载脂蛋白 A（apoA）与 90 天死亡率相关（P<0.05）。基于这些显著指标，我们设计并计算了一个新的预后评分=0.632×（腹水：无，1 分；轻度至中度，2 分；重度，3 分）+0.865×（HE：无，1 分；1-2 级，2 分；3-4 级，3 分）-0.413×三酰甘油（mmol/L）-2.171×apoA（g/L）。与四个著名的预后模型（MELD 评分、CTP 评分、CLIF-C OFs 和 CLIF-C ACLFs）相比，新的评分模型更准确，预测 HEV 引起的 ACLF 患者 28 天和 90 天无移植生存率的 auROCs 分别为 0.878 和 0.896。与 COSSH ACLF IIs 相比，我们的模型没有显著差异。测试数据也表现出良好的一致性。
本研究首次探讨了戊型肝炎与血清脂质之间的相关性，并为 HEV 引起的 ACLF 提供了一种新的简单有效的预后评分模型。
