基于白细胞衍生性指标建立肝硬化失代偿期患者自发性细菌性腹膜炎短期预后风险预测模型的价值研究

Value research of risk predictive model based on leukocyte-derived indexes for short-term prognosis in patients with decompensatory cirrhosis complicated with spontaneous bacterial peritonitis

目的基于白细胞衍生性指标建立并验证肝硬化失代偿期(DCC)患者自发性细菌性腹膜炎(SBP)短期预后的风险预测模型。方法纳入DCC并发SBP患者213例,按照收治时间将其分为模型组(142例)和检验组(71例),根据90 d预后情况再将模型组分为生存组(101例)和死亡组(41例)。收集所有患者一般临床资料及白细胞衍生性指标[中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)和淋巴细胞与单核细胞比值(LMR)]并分组进行比较。采用单因素和多因素logistic回归分析评估影响DCC并发SBP患者短期预后的危险因素,建立风险预测模型,采用受试者工作特征(ROC)曲线下面积(AUC)检验模型的预测效能,采用Hosmer-Lemeshow检验评估模型拟合度,检验组进行模型验证。结果死亡组年龄≥60岁、合并肝性脑病、肝肾综合征及消化道出血患者比例、腹水多形核细胞计数、腹水中性粒细胞计数、Child-Pugh评分和血肌酐(SCr)、总胆红素(TBIL)、NLR、PLR均高于生存组,LMR低于生存组(P<0.05)。多因素logistic回归分析结果显示,合并肝肾综合征及消化道出血、NLR≥1.85、PLR≥112.45和LMR<0.19均为影响DCC并发SBP患者短期预后的独立危险因素(P<0.05)。构建风险预测模型,预测概率P=1/[1+e(-2.835+1.145)×(合并肝肾综合征)+0.905×(合并消化道出血)+0.986×(NLR)+1.037×(PLR)+0.942×(LMR)];ROC曲线检验风险预测模型预测效能的AUC为0.876(P<0.05);Hosmer-Lemeshow拟合优度检验的χ^(2)=7.685(P=0.083)。检验组实际死亡率的符合率为97.13%,内部一致性较好。结论基于白细胞衍生性指标建立的DCC并发SBP患者短期预后的风险预测模型具有较好的预测效能。

Objective To construct and verify risk predictive model based on leukocyte-derived indexes for short-term prognosis in patients with decompensatory cirrhosis(DCC)complicated with spontaneous bacterial peritonitis(SBP).Methods A total of 213 patients with DCC complicated with SBP were divided into model group(142 cases)and verification group(71 cases).According to short-term prognosis within 90 d,patients in model group were divided into survival group(101 cases)and death group(41 cases)according admission time.The general clinical data and neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR)and lymphocyte to monocyte ratio(LMR)of all patients were recorded and grouped for comparison.The risk factors of short-term prognosis in patients with DCC complicated with SBP were analyzed by univariate and multivariate logistic regression analysis.The risk prediction model was constructed,predictive efficiency was detected by receiver operator characteristic(ROC)curve(AUC),and its fit was evaluated by Hosmer-Lemeshow test.Model verification was conducted in verification group.Results Proportion of patients with age≥60 years old,complicated with hepatic encephalopathy,hepatorenal syndrome and digestive tract hemorrhage,multinucleate cell count in peritoneal effusion,neutrophil count in peritoneal effusion,Child-Pugh score and SCr,TBIL,NLR,PLR in death group were higher than those in survival group,while LMR was lower than that in survival group(P<0.05).Multivariate logistic regression analysis showed that combined with hepatorenal syndrome and gastrointestinal bleeding,NLR≥1.85、PLR≥112.45 and LMR<0.19 were independent risk factors of short-term prognosis in patients with DCC complicated with SBP(P<0.05).Risk prediction model predicted the probability P=1/[1+e(-2.835+1.145)×(combined with hepatorenal syndrome)+0.905×(combined with gastrointestinal bleeding)+0.986×(NLR)+1.037×(PLR)+0.942×(LMR)],(AUC=0.876,P<0.05).Hosmer-Lemeshow goodness of fit test:χ~2=7.685(P=0.083).The coincidence rate of actual mortality in verification group was 97.13%,with good internal consistency.Conclusion Risk prediction model based on leukocyte-derived indexes has good predictive efficiency for short-term prognosis in patients with DCC complicated with SBP.