乙型肝炎病毒相关慢加急性肝衰竭的危险因素及其风险预测模型

Risk factors and predictive model for the progression of HBV-related acute-on-chronic liver failure

目的探讨影响乙型肝炎病毒相关慢加急性肝衰竭前期(hepatitis B virus related acute-on-chronic pre-liver failure,pre-ACHBLF)疾病进展的危险因素,建立新的预测模型。方法纳入97例pre-ACHBLF患者,根据4周内临床转归分为进展组和好转组,收集其临床资料进行多因素Logistic回归分析模型分析,探讨ACHBLF发生的影响因素,建立并评估模型的预测价值。结果血清总胆红素(total bilirubin,TBIL)、凝血酶原时间(prothrombin time,PT)、血清肌酐(creatinine,Cr)和血小板-白细胞比值(platelet-to-white blood cell ratio,PWR)与ACHBLF发生密切相关,构建ACHBLF预测模型为Logit(P)=-1.494+1.530×TBIL(mg/dl)+3.111×PT(s)-1.711×PWR-1.786×Cr(mg/dl),该模型Nagelkerke R2为0.558,Hosmer-Lemeshow检验显示预测效能为76.3%(P=0.490),曲线下面积为0.83,当评分高于最佳临界值13.88时,患者发生ACHBLF风险增高。结论本研究建立的模型对预测pre-ACHBLF的疾病进展有较高的价值。

Objective To investigate the risk factors associated with the development of hepatitis B virus related acute-on-chronic pre-liver failure(pre-ACHBLF)to ACHBLF,and establish a new predictive model.Methods A total of 97 patients with pre-ACHBLF were divided into progress group and improvement group according to their clinical outcomes.Clinical data were collected.Multivariate logistic regression analysis was performed to evaluate the independent risk factors associated with the occurrence of ACHBLF,and establish a new predictive model.Results Total bilirubin,prothrombin time,serum creatinine and the ratio of platelet-white blood cell were independent risk factors.The risk model for predicting the occurrence of ACHBLE was established,which was Logit(P)=-1.494+1.530×TBIL(mg/dl)+3.111×PT(s)-1.711×PWR-1.786×Cr(mg/dl).Goodness of fit test Nagelkerke R2 coefficient was 0.558.Hosmer-Lemeshow test showed that the predicted performance was 76.3%(P=0.490).The area under receiver operating characteristic carve(ROC)curve was 0.83 and the optimal threshold was 13.88,suggesting that the patients with scores higher than 13.88 had an increased risk of developing ACLF.Conclusion The predictive model established in this study has a high value in predicting the risk of disease progression from pre-ACHBLF to ACHBLF.