年龄-胆红素-国际标准化比率-肌酐评分对乙型肝炎相关慢加急性肝功能衰竭患者短期预后的评估价值

Short-term prognostic value of age-bilirubin-international normalized ratio-creatinine score in patients with hepatitis B virus-related acute-on-chronic liver failure

目的探讨年龄-胆红素-国际标准化比率-肌酐(ABIC)评分对乙型肝炎相关慢加急性肝功能衰竭(HBV-ACLF)患者短期预后的评估价值。方法回顾性连续纳入2017年1月至2019年12月于扬州大学医学院附属六合人民医院感染性疾病科住院治疗的HBV-ACLF患者191例,根据住院后90 d的临床转归分为生存组(129例)和死亡组(62例)。收集患者入院24 h内血红蛋白、白细胞、血小板、国际标准化比率(INR)、丙氨酸氨基转移酶(ALT)、白蛋白、总胆红素、γ-谷氨酰转移酶(γ-GT)、血肌酐、尿素氮,分别进行终末期肝病模型(MELD)评分、肝功能评分(CP)、ABIC评分、血清白蛋白-胆红素(ALBI)评分、慢性肝功能衰竭联盟器官功能衰竭(CLIF-C OF)评分。采用Cox回归模型分析HBV-ACLF患者90 d预后的影响因素,绘制受试者工作特征曲线(ROC)判断不同评分模型对90 d预后的评估价值,应用Medcalc软件进行曲线下面积(AUC)两两比较;采用K-M法进行生存分析。结果死亡组患者ABIC评分显著高于生存组[10.6(8.3,12.6)vs.8.5(6.4,10.4),Z=-5.385、P<0.001]。年龄、CP、ABIC、CLIF-C OF评分均为影响HBV-ACLF患者90 d预后的独立危险因素(χ^(2)=6.337、P=0.012,χ^(2)=6.131、P=0.013,χ^(2)=14.531、P<0.001,χ^(2)=7.369、P=0.007)。ABIC评分预测HBV-ACLF患者90 d预后的AUC显著高于MELD、ALBI评分(0.741 vs.0.658:Z=3.869、P<0.001,0.741 vs.0.647:Z=9.453、P<0.001),与CP、CLIF-C OF评分差异无统计学意义(0.741 vs.0.727:Z=1.078、P=0.281,0.741 vs.0.716:Z=1.441、P=0.150)。进一步探讨不同ABIC水平HBV-ACLF患者的预后,结果显示高ABIC(≥9.9)患者90 d生存率为47.6%,显著低于低ABIC(<9.9)患者(77.3%),差异有统计学意义(χ^(2)=19.515、P<0.001)。结论ABIC评分可作为HBVACLF患者短期预后的有效预测指标,ABIC评分大于9.9提示HBV-ACLF患者90 d的死亡风险较高。

Objective To investigate the prognostic value of age-bilirubin-international normalized ratio-creatinine(ABIC)score in the short-term prognosis of patients with hepatitis B virusrelated acute-on-chronic liver failure(HBV-ACLF).Methods Total of 191 patients with HBV-ACLF hospitalized in the Department of Infectious Diseases,Liuhe People’s Hospital,Yangzhou University Medical College from January 2017 to December 2019 were collected,retrospectively,and were divided into survival group(129 cases)and death group(62 cases)according to their 90-day prognosis.Hemoglobin(Hb),white blood cells(WBC),platelets,international normalized ratio(INR),alanine aminotransferase(ALT),albumin,total bilirubin,gamma glutamyltransferase(γ-GT),serum creatinine and urea nitrogen of all patients were collected within 24 hours after admission.The model for end-stage liver disease(MELD),Child-Pugh(CP),ABIC,albumin-bilirubin(ALBI)and CLIF consortium organ failure(CLIF-C OF)were scored,respectively.The prognostic factors of HBV-ACLF patients were analyzed by Cox regression model,the value of different scoring models for 90-day prognosis were analyzed by receiver operating characteristic curve(ROC),and area under the ROC curves(AUCs)were compared by Medcalc software.The survival analysis was carried out by K-M method.Results ABIC score of patients in death group was significantly higher than that of survival group[10.6(8.3,12.6)vs.8.5(6.4,10.4):Z=-5.385,P<0.001].Age(χ^(2)=6.337,P=0.012),CP(χ^(2)=6.131,P=0.013),ABIC(χ^(2)=14.531,P<0.001)and CLIF-C OF(χ^(2)=7.369,P=0.007)were all independent risk factors for 90-day prognosis of patients with HBV-ACLF,with significant differences.AUC of ABIC for 90-day mortality was significantly higher than that of MELD and ALBI[0.741(0.673-0.801)vs.0.658(0.586-0.725):Z=3.869,P=0.000;0.741(0.673-0.801)vs.0.647(0.575-0.715):Z=9.453,P<0.001],and there was no significant difference compared with AUCs of CP and CLIF-C OF[0.741(0.673-0.801)vs.0.727(0.658-0.789):Z=1.078,P=0.281;0.741(0.673-0.801)vs.0.716(0.646-0.778):Z=1.441,P=0.150].Further investigation on the prognosis of HBV-ACLF patients with different ABIC levels showed that the 90 d survival rate was 47.6%of patients with high ABIC(≥9.9),which was significantly lower than that of cases with low ABIC(<9.9)(77.3%),with significant difference(χ^(2)=19.515,P<0.001).Conclusions ABIC score could be used as an effective predictor of short-term prognosis in patients with HBV-ACLF,ABIC score>9.9 may predict high short-term mortality risk in patients with HBV-ACLF.