ALBI、NLR、FIB-4、MELD评分对血浆置换治疗慢加急性肝衰竭患者短期预后的预测价值

Short-term Prognostic Value of ALBI,NLR,FIB-4 and MELD Score in Patients With Acute-on-chronic Liver Failure Undergoing Plasma Exchange

背景:慢加急性肝衰竭(ACLF)病情进展迅速,病死率高,准确预测患者预后能指导制订个体化治疗方案,合理、有效地利用稀缺肝源。目的:探讨ALBI、NLR、FIB-4、MELD评分预测行血浆置换(PE)治疗ACLF患者短期预后的价值。方法:回顾性连续收集2015年1月—2019年7月在南通市第三人民医院行PE治疗的ACLF病例,根据入院后第3个月末的生存状态将入选病例分为好转组和恶化组(包括临床恶化、肝移植和死亡病例),采集治疗前实验室指标,计算ALBI、NLR、FIB-4、MELD评分。采用多因素logistic回归模型分析预后影响因素,建立联合预测模型。采用ROC曲线评估各单项评分和联合预测模型预测短期预后的效能。结果:共147例ACLF患者纳入研究,好转组71例,恶化组76例。恶化组ALBI、NLR、FIB-4、MELD评分均显著高于好转组(P<0.05)。多因素logistic回归分析显示,四项评分均为PE治疗ACLF患者短期预后的独立危险因素,ROC曲线下面积(AUC)分别为0.767、0.884、0.750和0.860。由logistic回归模型建立的三项联合(ALBI+NLR+FIB-4)和四项联合(ALBI+NLR+FIB-4+MELD)预测模型的AUC可提高至0.918和0.946。结论:ALBI、NLR、FIB-4、MELD评分对预测PE治疗ACLF患者的短期预后具有良好价值,四项联合预测模型预测价值更高。

Background:Acute-on-chronic liver failure(ACLF)is a rapid-developing critical illness with a high mortality.Accurate prediction of the prognosis of patients with ACLF can guide the individualized therapy,and effectively and rationally utilize the scarce liver source.Aims:To investigate the short-term prognostic value of ALBI,NLR,FIB-4,and MELD score in ACLF patients undergoing plasma exchange(PE).Methods:A retrospective analysis was conducted on clinical data of consecutive patients with ACLF undergoing PE from Jan.2015 to Jul.2019 at the Nantong Third People’s Hospital.According to the survival status at 3 months after admission,the eligible cases were allocated into improvement group and deterioration group(including clinical deterioration,liver transplantation and death cases).The laboratory parameters before PE were recorded to calculate the score of ALBI,NLR,FIB-4,and MELD.Multivariate logistic regression analysis was performed to identify the influencing factors for prognosis and a combined prognostic model was constructed.ROC curve was used to assess the performance of single and combined score for predicting the short-term prognosis.Results:A total of 147 ACLF patients were enrolled,71 in improvement group and 76 in deterioration group.ALBI,NLR,FIB-4,and MELD score were all significantly increased in deterioration group than in improvement group(P<0.05).Multivariate logistic regression analysis revealed that all four single score were independent risk factor for poor short-term prognosis of ACLF patients undergoing PE.Area under the ROC curve(AUC)was 0.767,0.884,0.750 and 0.860 for ALBI,NLR,FIB-4,and MELD,respectively.When using triple(ALBI+NLR+FIB-4)or quadruple(ALBI+NLR+FIB-4+MELD)combined score established by logistic regression model,AUC could increase to 0.918 and 0.946,respectively.Conclusions:ALBI,NLR,FIB-4,MELD score has a good value for evaluating the short-term prognosis of ACLF patients undergoing PE.Combined model including these four single score has higher predictive value.