4种评分系统对HBV相关慢加急性肝衰竭合并食管胃底静脉曲张出血患者短期预后的评估价值

Clinical value of 4 scoring systems in evaluating the short-term prognosis of patients suffering from HBV-ACLF complicated with esophageal gastric variceal bleeding

目的探讨LSPS、ALBI、MELD及CTP评分系统对HBV相关慢加急性肝衰竭合并食管胃底静脉曲张出血患者短期预后的应用价值。方法纳入2018年12月18日至2021年9月6日上海市公共卫生临床中心收治的HBV相关慢加急性肝衰竭合并食管胃底静脉曲张出血患者52例。根据28 d预后情况分为存活组35例和死亡组17例,观察对比两组患者的临床资料并计算评分,使用ROC曲线评估4个评分系统对纳入患者28 d和90 d死亡的预测效能。结果死亡组和存活组比较,TBil[395.6(97.9,562.9)比211.9(41.7,422.6)μmol/L]、门静脉内径[13(12.5,14)比12(10,13)mm]、脾直径[13.2(11.9,16.1)比11.8(11,12.05)cm]明显偏高(均P<0.05),肝性脑病(94.1%比11.4%)、肝肾综合征(100.0%比57.1%)、感染(100.0%比65.7%)发生率明显偏高(均P<0.05),ALBI[-2.3(-2.69,-1.87)比-2.7(-3.01,-2.37)]、MELD[18.94(11.8,38.6)比12.47(4.64,22.58)]及CTP[14(13,14)比11(9,12)]评分明显偏高(均P<0.05)。28 d死亡风险的ROC曲线分析显示LSPS、ALBI、MELD及CTP评分的AUC分别为0.533、0.620、0.664、0.848,CTP评分预测28 d病死率效能最好(P<0.05);90 d死亡风险的ROC曲线分析显示,LSPS、ALBI、MELD及CTP评分的AUC分别为0.633、0.586、0.656、0.805,CTP评分预测90 d病死率效能较高(P<0.05)。结论CTP评分预测HBV-ACLF并发EGVB患者短期预后效能显著。

Objective To investigate the clinical value of liver stiffness-spleen diameter-to-platelet ratio score(LSPS),albumin-bilirubin scoring model(ALBI),model for end-stage liver disease(MELD)and Child-Turcotte-Pugh(CTP)in evaluating short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF)and esophagealgastric variceal bleeding(EGVB).Methods Fifty-two patients with HBV-ACLF and EGVB admitted to our hospital from December 18,2018 to September 6,2021 were collected.According to 28-day prognosis,they were divided into survival group(35 cases)and death group(17 cases).The clinical data of patients were analyzed and the scores of the 4 scoring systems were calculated.The efficacy of the 4 scoring systems in predicting the 28-day and 90-day mortality was evaluated by receiver operating characteristic(ROC)curve.Results Compared with survival group,patients in death group had higher total bilirubin(TBIL)level[395.6(97.9,562.9)vs 211.9(41.7,422.6)umol/L],portal vein diameter[13(12.5,14)vs 12(10,13)mm]and spleen diameter[13.2(11.9,16.1)vs 11.8(11,12.05)cm].The incidence rates of hepatic encephalopathy(94.1%vs 11.4%),hepatorenal syndrome(100.0%vs 57.1%)and infections(100.0%vs 65.7%)(P<0.05)in the death group were significantly higher.The scores of ALBI[-2.3(-2.69,-1.87)vs(-2.7(-3.01,-2.37))],MELD[18.94(11.8,38.6)vs 12.47(4.64,22.58)]and CTP[14(13,14.5)vs 11(9,12)]of death group were significantly also higher.ROC curve analysis of the 28-day death risk showed that the area under the curve(AUC)of LSPS,ALBI,MELD and CTP scores were 0.533,0.620,0.664 and 0.848,suggesting the CTP scoring system was superior to the other three(P<0.05)in predicting the 28-day mortality.ROC curve analysis of the 90-day death risk showed that the AUC of LSPS,ALBI,MELD and CTP scores were 0.633,0.586,0.656 and 0.805,suggesting the CTP scoring system performed better in predicting the 90-day mortality(P<0.05).Conclusion CTP scoring system performs better in predicting the short-term prognosis of patients with HBV-ACLF and EGVB.