简化终末期肝病模型评分对人工肝治疗乙型肝炎相关慢加急性肝衰竭预后的预测价值

Value of simplified model for end-stage liver disease score in predicting the prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure treated with artificial liver support system

目的根据终末期肝病模型(MELD)评分客观指标提出简化MELD(sMELD)评分,评估其对人工肝治疗乙型肝炎相关慢加急性肝衰竭(HBV-ACLF)患者短期预后的预测价值。方法回顾性连续纳入2014—2019年在四川大学华西医院住院行人工肝治疗的HBV-ACLF患者601例,收集患者临床资料和90 d预后相关信息。计算sMELD评分并评价其预测效能。结果sMELD评分的受试者工作特征下面积(AUC)为0.757(95%CI:0.720~0.791),Brier分数为0.185(95%CI:0.171~0.199)。sMELD评分和MELD评分及其衍生评分系统的AUC相比,差异均无统计学意义(P>0.05)。sMELD评分为0~1、2~3和4~6分的HBV-ACLF患者90 d病死率分别为18.99%、50.84%和91.49%。结论sMELD评分可较准确地预测人工肝治疗HBV-ACLF患者短期预后。

Objective To propose a simplified model for end-stage liver disease(sMELD)score based on objective indicators of MELD score,and evaluate its predictive value for the short-term prognosis of patients with HBV-related acute-on-chronic liver failure(HBV-ACLF)treated with artificial liver support system(ALSS).Methods A total of 601 HBV-ACLF patients with ALSS therapy were retrospectively and continuously enrolled in West China Hospital of Sichuan University from 2014 to 2019.Clinical data and 90-day prognostic information were collected.sMELD score was calculated,and its predictive power was evaluated.Results The area under receiver operating characteristic(AUC)of sMELD score was 0.757(95%CI:0.720-0.791),and the Brier score was 0.185(95%CI:0.171-0.199).There was no significant difference in AUCs among the sMELD score and MELD score or its derived scoring system(P all>0.05).The 90-day mortality rates of patients with sMELD score of 0-1,2-3 and 4-6 were 18.99%,50.84%and 91.49%,respectively.Conclusions The sMELD score can be used to predict short-term prognosis of HBV-ACLF patients who received ALSS therapy.