基于NLR建立肝硬化合并肝性脑病患者短期死亡率的优化预测模型

Research on the establishment of an optimized prediction model of short-term mortality in patients with liver cirrhosis and hepatic encephalopathy based on NLR

目的分析肝硬化合并肝性脑病(HE)患者预后的危险因素,基于中性粒细胞/淋巴细胞比值(NLR)建立预测短期死亡率的优化模型。方法收集该院2016年1月至2019年11月的肝硬化合并HE住院患者的人口学及实验室检查资料,应用logistic回归分析患者30 d死亡的危险因素并建立预测模型,同时比较其与Child-Turcotte-Pugh(CTP)评分、终末期肝病模型(MELD)分数、血清钠与终末期肝病模型的联合公式(MELD-Na)分数预测患者死亡率的性能。结果共纳入214例肝硬化合并HE患者,其中死亡组72例,建立预测模型:NINGH=8.417+0.06×NLR-0.070×GLB(g/L)-1.062×HDL-L(mmol/L)-0.064×Na^(+)(mmol/L)+1.004×INR。其预测肝硬化合并HE患者短期死亡率的受试者工作特征(ROC)曲线下面积(AUC)为0.855,高于CTP评分、MELD分数(P<0.05),其与MELD-Na分数的AUC比较差异无统计学意义(P>0.05)。结论基于NLR建立的预测模型NINGH对肝硬化合并HE患者短期死亡率的预测价值较CTP分数、MELD分数好。

Objective To analyze the risk factors for the prognosis of patients with liver cirrhosis and hepatic encephalopathy(HE),and to establish an optimized model for predicting short-term mortality based on the neutrophil/lymphocyte ratio(NLR).Methods The demographic and laboratory examination data of patients with liver cirrhosis and HE in the hospital from January 2016 to November 2019 were collected.Logistic regression was used to analyze the risk factors of patients′mortality within 30 days and then a prediction model was established based on the statistically significant factors.At the same time,its performance of predicting patient′s mortality was compared with Child-Turcotte-Pugh(CTP)score,end-stage liver disease model(MELD)score,serum sodium and end-stage liver disease model combined formula(MELD-Na)score.Results A total of 214 patients with liver cirrhosis and HE were included,of which 72 were in the death group.The prediction model was established:NINGH=8.417+0.06×NLR-0.070×GLB(g/L)-1.062×HDL-L(mmol/L)-0.064×Na^(+)(mmol/L)+1.004×INR.Its receiver operating characteristic(ROC)area under the curve(AUC)for predicting short-term mortality in patients with liver cirrhosis and HE was 0.855,which was significantly higher than that of CTP score,MELD score(P<0.05),but there was no statistically significant difference between MELD-Na score and NINGH.Conclusion Compared with the CTP score,MELD score,the prediction model NINGH established based on the NLR performed a better predictive value for the short-term mortality of patients with liver cirrhosis and HE.