Xue H, Ding M C, Ding W, Zhang L, Chen Y, Bian Z L
Department of Hepatology, Affiliated Nantong Hospital 3 of Nantong University, Nantong Third People's Hospital, Nantong 226000, China.
Nantong University Medical School, Nantong 226001, China.
Zhonghua Yi Xue Za Zhi. 2025 Jun 24;105(24):1989-1996. doi: 10.3760/cma.j.cn112137-20250222-00424.
To investigate the predictive value of liver-to-spleen volume ratio (LSR) for short-term prognosis in patients with hepatitis B virus -related acute-on-chronic liver failure (HBV-ACLF). This retrospective study enrolled 168 HBV-ACLF patients diagnosed at Nantong Third People's Hospital between September 2019 and August 2023. Participants were stratified into survival (=106) and non-survival (=62) groups based on 90-day outcomes. Baseline clinical parameters and laboratory findings were recorded; and abdominal CT measurements were collected to calculate LSR. Comparative analysis of clinical characteristics was performed between groups. Cox proportional hazards regression analyses identified clinical predictors. Restricted cubic spline (RCS) modeling explored the dose-response relationship between baseline LSR and mortality risk. Receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA) were employed to compare the prognostic performance of LSR with established scoring systems: Chinese Group on the Study of Severe Hepatitis B-acute-on-chronic liver failure Ⅱ score (COSSH-ACLF Ⅱ), model for end-stage liver disease (MELD), MELD combined with serum sodium (MELD-Na). Using the Delong test to compare differences in the areas under different curves (AUC). A total of 168 patients were included, with an average age of (55.0±14.1) years, of which 110 were male. Among them, the survival group consisted of 106 cases, with an average age of (53.7±13.8) years and 70 males; the death group included 62 cases, with an average age of (57.4±14.4) years and 40 males.The survival group had higher results compared to the death group in LSR [(, )] [3.1 (2.3, 4.5) vs 1.2 (1.0, 1.5)], liver volume [1 164.3 (1 002.1, 1 383.4) vs 713.9 (653.6, 884.2) cm], and platelet count [109.0 (62.0, 147.8)×10/L vs 78.0 (53.3, 133.3)×10/L] (all <0.05). The survival group demonstrated lower values in the proportion of hepatic encephalopathy, international standardized ratio, lactate, total bilirubin, COSSH-ACLF Ⅱ score, MELD and MELD-Na scores (all <0.05). The results of the Cox proportional hazards regression modeling analysis demonstrated that hepatic encephalopathy (=2.01, 95%CI:1.11-3.63) and LSR (=0.17, 95%:0.10-0.30) as influencing factors of the death of patients with HBV-ACLF. RCS revealed a nonlinear association between baseline LSR and mortality risk (<0.001, =0.019). ROC analysis demonstrated the AUC of LSR [0.883 (95%:0.82-0.94)] was superior to COSSH-ACLF Ⅱ scores[0.77 (95%: 0.69-0.84)], MELD [0.68 (95%: 0.60-0.76)], and MELD-Na scores [0.64 (95%: 0.55-0.72)] (all <0.05). Calibration curves and DCA confirmed LSR's clinical utility in predicting the short-term prognosis in HBV-ACLF patients. LSR shows significant predictive value for short-term prognosis in HBV-ACLF patients.
探讨肝脾体积比（LSR）对乙型肝炎病毒相关慢加急性肝衰竭（HBV-ACLF）患者短期预后的预测价值。本回顾性研究纳入了2019年9月至2023年8月在南通市第三人民医院确诊的168例HBV-ACLF患者。根据90天的结局将参与者分为生存组（=106）和非生存组（=62）。记录基线临床参数和实验室检查结果；收集腹部CT测量值以计算LSR。对两组间的临床特征进行比较分析。Cox比例风险回归分析确定临床预测因素。限制立方样条（RCS）建模探索基线LSR与死亡风险之间的剂量反应关系。采用受试者工作特征（ROC）曲线、校准图和决策曲线分析（DCA）比较LSR与已建立的评分系统（乙型肝炎重症研究组-慢加急性肝衰竭Ⅱ评分（COSSH-ACLFⅡ）、终末期肝病模型（MELD）、MELD联合血清钠（MELD-Na））的预后性能。使用DeLong检验比较不同曲线下面积（AUC）的差异。共纳入168例患者，平均年龄（55.0±14.1）岁，其中男性110例。其中，生存组106例，平均年龄（53.7±13.8）岁，男性70例；死亡组62例，平均年龄（57.4±14.4）岁，男性40例。生存组的LSR[（，）][3.1（2.3，4.5）vs 1.2（1.0，1.5）]、肝脏体积[1 164.3（1 002.1，1 383.4）vs 713.9（653.6，884.2）cm]和血小板计数[109.0（62.0，147.8）×10/L vs 78.0（53.3，133.3）×10/L]均高于死亡组（均<0.05）。生存组在肝性脑病比例、国际标准化比值、乳酸、总胆红素、COSSH-ACLFⅡ评分、MELD和MELD-Na评分方面的值较低（均<0.05）。Cox比例风险回归建模分析结果表明，肝性脑病（=2.01，95%CI：1.11-3.63）和LSR（=0.17，95%：0.10-0.30）是HBV-ACLF患者死亡的影响因素。RCS显示基线LSR与死亡风险之间存在非线性关联（<0.001，=0.019）。ROC分析表明，LSR的AUC[0.883（95%：0.82-0.94）]优于COSSH-ACLFⅡ评分[0.77（95%：0.69-0.84）]、MELD[0.68（95%：0.60-0.76）]和MELD-Na评分[0.64（95%：0.55-0.72）]（均<0.05）。校准曲线和DCA证实了LSR在预测HBV-ACLF患者短期预后方面的临床实用性。LSR对HBV-ACLF患者的短期预后具有显著的预测价值。
