Pinto Letícia Pereira, Marroni Claudio Augusto, Czermainski Juliana, Dahlem Maria Luiza Fernandes, Carteri Randhall B, Fernandes Sabrina Alves
Department of Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre 90050-170, Brazil.
Department of Veterinary Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre 91540-000, Brazil.
World J Methodol. 2023 Sep 20;13(4):238-247. doi: 10.5662/wjm.v13.i4.238.
In 2019, cirrhosis accounted for 2.4% of global deaths. The projection for 2030 is an increase in this index. In recent years, hospitalization costs have escalated by 36% for compensated cirrhosis and 24% for decompensated cirrhosis. Therefore, it is necessary to identify a tool capable of predicting the mortality of these patients according to their clinical condition and consequently extending their survival time. Different studies have shown that the phase angle (PA) can be a feasible method in clinical practice, with the potential to guide assertive patient management in the therapeutic of chronic liver disease.
To evaluate the prognostic role of PA in cirrhotic patients over a 15-year follow-up period.
Retrospective cohort study with 129 cirrhotic patients of both sexes over 18 years old. Diagnosis of cirrhosis by liver biopsy. The first year of data collection was 2007, and data regarding outcomes was collected in 2023. Data were gathered from medical records, such as esophageal varices (EV), EV bleeding, ascites, spontaneous bacterial peritonitis (SBP), encephalopathy, laboratory findings and PA. The cut-off value for the PA was 5.4°, a value described in 2012 by Fernandes for 129 patients evaluated in this study and the cut-off points for the Brazilian population presented in percentiles (P), as described by Mattiello . The mortality was assessed using the PA percentile through Kaplan-Meier curves and multivariate binary logistic regression models.
Patients were divided into two groups according to the PA 5.4th (PA > 5.4°, = 40; PA ≤ 5.4°, = 89) PA percentile (< P50, = 56; ≥ P50 = 73). The percentile classification was more accurate in identifying long-term deaths than the 5.4º PA. Patients with < P50 had a higher number of relevant complications such as ascites, SBP, liver encephalopathy and HCC. PA is strongly correlated with serum albumin ( < 0.001), International Normalized Ratio ( = 0.01), total bilirubin ( = 0.02) and direct bilirubin ( = 0.003). PA is correlated with survival time ( < 0.001) and length of stay ( = 0.02). Logistic regression analysis shows that an increase of 1° in PA enlarges the cirrhotic patient's chance of survival by 17.7%.
PA is a good predictor of morbidity and mortality for cirrhotic patients. The PA by percentile showed greater sensitivity in predicting mortality compared to the cut-off point of 5.4º.
2019年，肝硬化导致的死亡占全球死亡人数的2.4%。预计到2030年这一指标将会上升。近年来，代偿期肝硬化的住院费用上涨了36%，失代偿期肝硬化的住院费用上涨了24%。因此，有必要确定一种能够根据患者临床状况预测其死亡率并进而延长其生存时间的工具。不同研究表明，相位角（PA）在临床实践中可能是一种可行的方法，具有在慢性肝病治疗中指导积极的患者管理的潜力。
评估PA在15年随访期内对肝硬化患者的预后作用。
对129例18岁以上的肝硬化患者进行回顾性队列研究。通过肝活检诊断肝硬化。数据收集的第一年是2007年，2023年收集了关于结局的数据。数据从病历中收集，如食管静脉曲张（EV）、EV出血、腹水、自发性细菌性腹膜炎（SBP）、肝性脑病、实验室检查结果和PA。PA的临界值为5.4°，这是费尔南德斯在2012年对本研究中评估的129例患者所描述的值，以及马蒂埃洛所描述的巴西人群的百分位数（P）临界值。通过Kaplan-Meier曲线和多变量二元逻辑回归模型，使用PA百分位数评估死亡率。
根据PA第5.4百分位数（PA>5.4°，n = 40；PA≤5.4°，n = 89）将患者分为两组（<P50，n = 56；≥P50，n = 73）。百分位数分类在识别长期死亡方面比5.4°PA更准确。<P50的患者有更多相关并发症，如腹水、SBP、肝性脑病和肝癌。PA与血清白蛋白（P<0.001）、国际标准化比值（P = 0.01）、总胆红素（P = 0.02）和直接胆红素（P = 0.003）密切相关。PA与生存时间（P<0.001）和住院时间（P = 0.02）相关。逻辑回归分析表明，PA每增加1°，肝硬化患者的生存机会增加17.7%。
PA是肝硬化患者发病率和死亡率的良好预测指标。与5.4°的临界值相比，PA百分位数在预测死亡率方面表现出更高的敏感性。
