重症酒精性肝炎患者临床特征与预后分析

Clinical characteristics and prognosis of patients with severe alcoholic hepatitis

目的分析住院重症酒精性肝炎(severe alcoholic hepatitis,SAH)患者临床特征,28d、90d预后及相关预后因素。方法采用回顾性研究方法,收集2017年1月至2020年12月于北京佑安医院住院治疗的161例非肝移植SAH患者的临床、实验室检查及28d、90d预后资料,分析SAH患者基线临床特征和28d、90d预后及影响预后的相关预测因素。结果(1)在90d随访期内,166例SAH患者肝移植者5例,占3.01%,161例非肝移植SAH患者中位年龄为49(40,56)岁,肝硬化基础占92.5%,终末期疾病模型(model for end-stage liver disease,MELD)和修正的Maddrey判别函数(Maddrey discriminant function,MDF)评分分别为13.49(10.56,18.69)分和64.63(46.95,84.87)分;28d、90d死亡率分别为8.7%和23.6%,仅6.8%SAH患者接受了糖皮质激素治疗。(2)Cox回归分析发现高国际标准化比值(international normalized ratio,INR)(HR=2.572,95%CI:1.300~5.087,P=0.07)和急性肾损伤(acute kidney injury,AKI)(HR=4.292,95%CI:1.325~13.899,P=0.015)是SAH患者28d死亡的独立预测因子;高INR(HR=2.114,95%CI:1.278~3.499,P=0.004)和肝性脑病(hepatic encephalopathy,HE)(HR=2.272,95%CI:1.155~4.472,P=0.018)是SAH患者90d死亡的独立预测因子。(3)疾病严重评分预测28d死亡情况,以MDF和MELD评分表现为优,cutoff值分别为74.27和16.77;预测90d死亡情况,则以MELD和ABIC表现为优,cutoff值分别为16.77和7.69。结论SAH患者短期死亡率较高,仅少数接受皮质类固醇治疗。急性肾损伤、INR和肝性脑病为SAH患者短期死亡的独立预测因素。预测28d死亡情况以MDF和MELD评分为优,而在预测90d死亡情况方面,则以MELD和ABIC表现更佳。

Objective To analyze the clinical characteristics and prognosis at 28d and 90d and related prognostic factors of in-hospital patients with severe alcoholic hepatitis(SAH).Methods A total of 161 SAH in-hospital patients without liver transplantation in the Beijing You’an Hospital were retrospectively enrolled from January 2017 to December 2020.The clinical data,laboratory data and outcomes at 28d and 90d of follow-up of were collected and analyzed,and relevant predictive factors affecting outcomes were identified.Results(1)During the 90d follow-up period,5 cases(3.01%)of 166 SAH patients received liver transplantation.The median age of 161 non-liver transplant SAH patients was 49(40,56)years old.The preexisting cirrhosis cases accounted for 92.5%.The median of the model for end-stage disease(MELD)and modified Maddrey discriminant function(MDF)were 13.49(10.56,18.69)and 64.95(46.95,84.87),respectively;The 28d and 90d mortality were 8.7% and 23.6%,respectively.Only 6.8% of SAH patients received glucocorticoid treatment.(2) Cox regression analysis found that high international normalized ratio(INR)(HR=2.572,95%CI:1.300~5.087,P=0.07)and acute kidney injury(AKI)(HR=4.292,95%CI:1.325~13.899,P=0.015)were independent predictors of 28d mortality of SAH patients;High INR(HR =2.114,95%CI:1.278~3.499,P =0.004)and hepatic encephalopathy(HE)(HR=2.272,95%CI:1.155~4.472,P=0.018)were independent predictors of 90d mortality in SAH patients.(3)The disease severity score predicted the 28d mortality rate.The cutoff values of MDF and MELD scores were 74.27 and 16.77,respectively;For 90d mortality prediction,MELD and ABIC showed the good quality with the cutoff values of 16.77 and 7.69 respectively.Conclusions The short-term mortality of SAH patients is high,and only a few patients received corticosteroid treatment.Acute renal injury,INR and HE are the independent predictors of short-term mortality.MDF and MELD scores are better for predicting 28d mortality,while MELD and ABIC are better for predicting 90d mortality.