Lyu Chunyan, Han Jun, Kang Naling, Zeng Dawu, Davgadorj Chantsalmaa, Ge Lina, Zhou Meifang, Mao Richeng, Yan Yan
Clinical Medical Research Center, The Fifth People's Hospital of Wuxi, Wuxi, China.
Clinical Medical Resarch Center, Wuxi Clinical College of Nantong University, Wuxi, China.
Gastroenterol Res Pract. 2024 Dec 18;2024:5512889. doi: 10.1155/grp/5512889. eCollection 2024.
The prognosis of patients with liver failure (LF) depends significantly on the etiology and clinical indicators. This analysis of these basic indicators can help provide a basis for the study of predictive outcome indicators. We collected the data from multiple centers in Southeast China, including subclasses of acute liver failure (ALF), subacute liver failure (SLF), acute-on-chronic liver failure (ACLF), subacute-on-chronic liver failure (SALF), and chronic liver failure (CLF). Multivariate logistic regression analysis was used to screen for clinical indicators of nonsurvivors. We analyzed receiver operating characteristic (ROC) curves and cutoff values to assess the prognostic criteria. Hepatitis B virus (HBV) infection is the leading etiology of patients with LF (64.52% (411/637)). SALF (41.36%) and CLF (32.30%) are the main subclasses of the hepatitis B virus-related liver failure (HBV-LF) group and the non-HBV-related LF group in Southeast China, respectively. Between 2018 and 2020, the incidence of HBV-LF decreased significantly, ranging from 72.36% to 59.74%, and the spontaneous survival rates of patients with HBV-LF were substantially lower than those of non-HBV-LF patients (36.43%44.93% vs. 58.97%63.64%). Infection and cirrhosis were the leading causes of death in both groups. The age and total bilirubin value of the nonsurvivors with HBV-LF were significantly higher, and the number of days of hospitalization was significantly shorter than that of the survivors. The ages of the nonsurvivors in the non-HBV-LF group were significantly higher than those of the survivors. The prothrombin time-international normalized ratio (PT-INR) is 2.05, 1.92, or 2.11, and antithrombin III (AT III) is 24.50%, which are proposed as prognostic criteria for the HBV-SALF (hepatitis B virus-related subacute-on-chronic liver failure), non-HBV-SLF (non-hepatitis B virus-related subacute liver failure), non-HBV-ACLF (non-hepatitis B virus-related acute-on-chronic liver failure), and HBV-ALF (hepatitis B virus-related acute liver failure) subclasses, respectively. The incidence of HBV-LF is decreasing annually. AT III, as an independent prognostic criterion, has excellent discriminative ability for the outcomes of the HBV-ALF subclass.
肝衰竭（LF）患者的预后很大程度上取决于病因和临床指标。对这些基本指标进行分析有助于为预测结局指标的研究提供依据。我们收集了中国东南部多个中心的数据，包括急性肝衰竭（ALF）、亚急性肝衰竭（SLF）、慢加急性肝衰竭（ACLF）、慢加亚急性肝衰竭（SALF）和慢性肝衰竭（CLF）的亚类。采用多因素逻辑回归分析筛选非存活者的临床指标。我们分析了受试者工作特征（ROC）曲线和临界值以评估预后标准。乙型肝炎病毒（HBV）感染是LF患者的主要病因（64.52%（411/637））。SALF（41.36%）和CLF（32.30%）分别是中国东南部HBV相关肝衰竭（HBV-LF）组和非HBV相关LF组的主要亚类。2018年至2020年期间，HBV-LF的发病率显著下降，从72.36%降至59.74%，HBV-LF患者的自发存活率显著低于非HBV-LF患者（36.43%44.93%对58.97%63.64%）。感染和肝硬化是两组的主要死亡原因。HBV-LF非存活者的年龄和总胆红素值显著更高，住院天数显著短于存活者。非HBV-LF组非存活者的年龄显著高于存活者。凝血酶原时间国际标准化比值（PT-INR）为2.05、1.92或2.11，抗凝血酶III（AT III）为24.50%，分别被提议作为HBV-SALF（HBV相关慢加亚急性肝衰竭）、非HBV-SLF（非HBV相关亚急性肝衰竭）、非HBV-ACLF（非HBV相关慢加急性肝衰竭）和HBV-ALF（HBV相关急性肝衰竭）亚类的预后标准。HBV-LF的发病率逐年下降。AT III作为独立的预后标准，对HBV-ALF亚类的结局具有出色的判别能力。
