Liu Linxiang, Huang Chenkai, Zhang Yue, Zhu Xuan
Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, China.
Jiangxi Clinical Research Center for Gastroenterology, Nanchang, Jiangxi, 330006, China.
Heliyon. 2024 Sep 18;10(19):e37983. doi: 10.1016/j.heliyon.2024.e37983. eCollection 2024 Oct 15.
Acute-on-chronic liver failure (ACLF) is a syndrome characterized by systemic inflammation, leading to high short-term mortality. The lymphocyte to high-density lipoprotein ratio (LHR) has been introduced as a novel marker of inflammation. However, its role as a prognostic inflammatory biomarker in the context of hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) has received limited attention.
We retrospectively included 272 patients with HBV-ACLF who met the definition of APALC. Data on clinical features and laboratory tests were collected from medical records within 24 h. Logistic regression was used to identify risk factors for poor short-term prognosis, and LHR-based prediction () models were constructed based on risk factors. Furthermore, the accuracy of the LHRB model was validated through rigorous testing.
In the survival and death groups, there were statistical differences in their CTP, MELD, MELD-Na, COSSH-ACLF II scores, and LHR. Multivariate logistic regression identified seven predictors significantly associated with 28-day mortality. Furthermore, statistically significant differences in short-term mortality and certain clinical laboratory tests for poor prognosis were observed between the high and low LHR groups. To assess the predictive performance of various models in terms of short-term mortality, the area under the receiver operating characteristic curve (AUROC) was calculated. The AUROC values for the CTP, MELD, MELD-Na, COSSH-ACLF II, and models were found to be 0.725, 0.788, 0.772, 0.871, and 0.877, respectively. The results in the validation group were similar to those in the training group, and the validation results suggested excellent performance of the model.
LHR levels have the potential to serve as indicators for the prognosis of HBV-ACLF. Additionally, the recently developed model offers an accessible risk assessment tool.
慢加急性肝衰竭（ACLF）是一种以全身炎症为特征的综合征，导致短期死亡率很高。淋巴细胞与高密度脂蛋白比值（LHR）已被引入作为一种新的炎症标志物。然而，其作为乙型肝炎病毒相关慢加急性肝衰竭（HBV-ACLF）背景下的预后炎症生物标志物的作用受到的关注有限。
我们回顾性纳入了272例符合APALC定义的HBV-ACLF患者。在24小时内从病历中收集临床特征和实验室检查数据。采用逻辑回归确定短期预后不良的危险因素，并基于危险因素构建基于LHR的预测模型。此外，通过严格测试验证了LHRB模型的准确性。
在生存组和死亡组中，他们的CTP、MELD、MELD-Na、COSSH-ACLF II评分和LHR存在统计学差异。多因素逻辑回归确定了7个与28天死亡率显著相关的预测因素。此外，高LHR组和低LHR组在短期死亡率和某些预后不良的临床实验室检查方面存在统计学显著差异。为了评估各种模型在短期死亡率方面的预测性能，计算了受试者操作特征曲线下面积（AUROC）。发现CTP、MELD、MELD-Na、COSSH-ACLF II和模型的AUROC值分别为0.725、0.788、0.772、0.871和0.877。验证组的结果与训练组相似，验证结果表明模型性能优异。
LHR水平有可能作为HBV-ACLF预后的指标。此外，最近开发的模型提供了一种易于使用的风险评估工具。
