ALBI评分联合PCT在肝硬化腹水患者自发性细菌性腹膜炎的预测作用

The predictive effect of ALBI score combined with PCT in spontaneous bacterial peritonitis in patients with liver cirrhosis and ascites

目的探究白蛋白-胆红素(albumin-bilirubin,ALBI)评分联合降钙素原(procalcitonin,PCT)在肝硬化腹水患者自发性细菌性腹膜炎(spontaneous bacterial peritonitis,SBP)的预测价值。方法回顾性纳入2017年6月至2021年7月我院住院治疗的376例肝硬化腹水患者,根据患者住院期间是否发生SBP,将其分为SBP组109例(28.99%)和非SBP组267例(71.01%)。通过电子病历系统收集患者入院时的临床资料,采用多因素Logistic回归分析肝硬化腹水患者住院期间发生SBP的独立危险因素。采用ROC曲线评定ALBI评分联合PCT预测SBP发生的性能。结果单因素分析显示,SBP组肝性脑病比例、PCT、国际标准化比值、MELD、CTP、ALBI评分均高于非SBP组(P<0.05)。多因素Logistic回归分析结果显示,ALBI评分(OR=1.802,95%CI:1.153~2.818,P=0.009)、PCT(OR=1.374,95%CI:1.026~1.841,P=0.033)是发生肝硬化腹水患者住院期间发生SBP的独立危险因素。ROC曲线分析显示,ALBI评分、PCT预测肝硬化腹水患者住院期间发生SBP的AUC分别为0.762(95%CI:0.686~0.838)、0.719(95%CI:0.648~0.790),二者联合预测的AUC为0.865(95%CI:0.816~0.914),敏感性为80.73%,特异性为76.78%。结论ALBI评分及血清PCT升高是肝硬化腹水患者住院期间发生SBP的独立危险因素,在SBP的发生中具有较好的预测效能。

Objective To explore the predictive value of albumin-bilirubin(ALBI)score combined with procalcitonin(PCT)in spontaneous bacterial peritonitis(SBP)in patients with liver cirrhosis and ascites.Methods Retrospectively enrolled 376 patients with liver cirrhosis and ascites who were hospitalized in our hospital from Jun.2017 to Jul.2021.According to whether the patients had SBP during hospitalization,they were divided into SBP group 109 cases(28.99%)and non-SBP group 267 cases(71.01%).The clinical data of patients at admission was collected through the electronic medical record system,and the independent risk factors of SBP in patients with liver cirrhosis and ascites were analyzed by multivariate Logistic regression.ROC curve was used to evaluate the performance of ALBI score combined with PCT in predicting the occurrence of SBP.Results Univariate analysis showed that the proportion of hepatic encephalopathy,PCT,international standardized ratio,MELD,CTP,and ALBI scores in SBP group were higher than those in non-SBP group(P<0.05).The results of multivariate Logistic regression analysis showed that ALBI score(OR=1.802,95%CI:1.153-2.818,P=0.009)and PCT(OR=1.374,95%CI:1.026-1.841,P=0.033)were the occurrence of liver cirrhosis independent risk factors for SBP in patients with ascites during hospitalization.ROC curve analysis showed that ALBI score and PCT predicted the AUC of SBP in patients with liver cirrhosis and ascites during hospitalization were 0.762(95%CI:0.686-0.838)and 0.719(95%CI:0.648-0.790),respectively,and the AUC predicted by the combination of the two was 0.865(95%CI:0.816-0.914),the sensitivity was 80.73%,and the specificity was 76.78%.Conclusion ALBI score and serum PCT are independent risk factors for SBP in patients with liver cirrhosis and ascites during hospitalization,and they have good predictive power in the occurrence of SBP.