不同评分对慢加急性肝衰竭患者预后判断的应用价值比较

Comparison of the prognostic values of different scores in patients with acute-on-chronic liver failure

目的了解亚太肝病研究学会慢加急性肝衰竭研究联盟评分(AARC-ACLF)和终末期肝病模型(MELD)对ACLF患者预后判断的应用价值。方法选取2019年1月1日至2021年7月31日新疆医科大学第一附属医院340例ACLF患者,根据患者120天生存结局分为生存组(200例)和死亡组(140例),比较生存组和死亡组入院基线、第7天、第14天、第28天的AARC-ACLF、MELD评分差异,应用ROC曲线下面积(AUC)比较两种评分的预测价值。结果死亡组基线AARC-ACLF、MELD分别为9.0(8.0,11.0)分和25.5(21.0,31.8)分,高于生存组的8.0(7.0,9.0)分和23.0(20.0,26.0)分(Z=-6.44和-4.58,P均<0.001)。第7天、14和28天时,AARC-ACLF所得AUC分别为0.774、0.784和0.833,AARC-ACLF评分最佳临界值均为9.0分,MELD评分所得AUC分别为0.711、0.819和0.761,MELD评分最佳临界值分别为25.0、23.0和22.0分;AARC-ACLF与MELD评分AUC差异均无统计学意义(Z=1.58、0.71和0.94,P=0.114、0.481和0.350)。结论AARC-ACLF和MELD评分在入院时、第7、14和28天时预测ACLF患者的预后方面效果相近。动态计算AARC-ACLF和MELD评分,可帮助判断疗效,指导治疗决策。

Objective To understand the prognostic values of Asian-Pacific Association for the Study of the Liver(APASL)acute-on-chronic liver failure(ACLF)research consortium(AARC-ACLF)and end-stage liver disease model(MELD)in patients with ACLF.Methods A total of 340 patients with ACLF in the First Affiliated Hospital of Xinjiang Medical University from January 1,2019 to July 31,2021 were selected and divided into survival group(200 cases)and death group(140 cases)according to the 120-day survival outcome.AARC-ACLF and MELD scores were compared between the survival and death group at admission baseline,days 7,14 and 28.The predictive values of the two scores were compared using the area under ROC curve(AUC).Results The AARC-ACLF and MELD in the death group were 9.0(8.0,11.0)and 25.5(21.0,31.8),which were higher than those of 8.0(7.0,9.0)and 23.0(20.0,26.0)in the survival group(Z=-6.44 and-4.58,P both<0.001).The AUCs obtained from the AARC-ACLF were 0.774,0.784 and 0.833 at day 7,14 and 28,respectively,and the optimal cut-off value of the AARC-ACLF was 9.0.The AUCs obtained from MELD were 0.711,0.819 and 0.761 at day 7,14 and 28,respectively,and the optimal cut-off values of the MELD were 25.0,23.0 and 22.0,respectively.There was no significant difference in AUCs between AARC-ACLF and MELD scores(Z=1.58,0.71 and 0.94,P=0.114,0.481 and 0.350).Conclusions AARC-ACLF and MELD scoring systems are similar in predicting the prognosis of patients with ACLF at admission,day 7,14 and 28.Dynamic calculation of AARC-ACLF and MELD scores is conducive to efficacy assessment and treatment decisions.