肝硬化合并上消化道出血患者预后的影响因素及mNUTRIC评分、PALBI评分和预后营养指数的预测价值分析

Influencing Factors of the Prognosis of Patients with Cirrhosis Complicated with Upper Gastrointestinal Bleeding and the Predictive Value Analysis of mNUTRIC Score,PALBI Score and Prognostic Nutritional Index

目的:分析肝硬化合并上消化道出血(UGIB)患者预后的影响因素并探讨改良危重症营养风险(mNUTRIC)评分、血小板-白蛋白-胆红素(PALBI)评分联合预后营养指数(PNI)对死亡风险的预测价值。方法:选取2020年1月~2022年5月我院收治的131例肝硬化合并UGIB患者,根据28 d内是否死亡分为死亡组(n=25)和存活组(n=106)。收集患者临床资料,计算mNUTRIC评分、PALBI评分和PNI。采用单因素和多因素Logistic回归分析肝硬化合并UGIB患者死亡的影响因素,绘制受试者工作特征(ROC)曲线分析mNUTRIC评分、PALBI评分联合PNI对肝硬化合并UGIB患者死亡风险的预测价值。结果:单因素分析显示,与存活组比较,死亡组Child-Pugh分级、输血量、休克比例、腹水比例、肝性脑病比例、C反应蛋白、胆红素、γ-谷氨酰转肽酶、碱性磷酸酶、谷草转氨酶、谷丙转氨酶、国际标准化比值、mNUTRIC评分、PALBI评分更高,平均动脉压、白蛋白、淋巴细胞计数、PNI更低(P<0.05)。多因素Logistic回归分析显示,Child-Pugh分级C级、输血量增加、休克、腹水、肝性脑病、胆红素升高、mNUTRIC评分(较高)、PALBI评分(较高)为肝硬化合并UGIB患者死亡的危险因素,PNI(较高)为保护因素(P<0.05)。ROC曲线分析显示,mNUTRIC评分、PALBI评分、PNI单独与联合预测肝硬化合并UGIB患者死亡风险的曲线下面积(AUC)分别为0.845、0.817、0.771、0.942,mNUTRIC评分、PALBI评分、PNI联合预测肝硬化合并UGIB患者死亡风险的AUC大于单独预测。结论:Child-Pugh分级、输血量、休克、腹水、肝性脑病、胆红素、mNUTRIC评分、PALBI评分、PNI为肝硬化合并UGIB患者预后的影响因素,mNUTRIC评分、PALBI评分、PNI联合预测肝硬化合并UGIB患者死亡风险的临床价值较高。

Objective: To analyze the influencing factors of the prognosis of patients with cirrhosis complicated with upper gastrointestinal bleeding(UGIB) and to investigate the predictive value of the modified nutrition risk in critically ill(mNUTRIC) score,platelet-albumin-bilirubin(PALBI) score and prognostic nutritional index(PNI) on the risk of death. Methods: A total of 131 patients with cirrhosis complicated with UGIB who were admitted to our hospital from January 2020 to May 2022 were selected, and they were divided into death group(n=25) and survival group(n=106) according to whether they died after 28d. Clinical data were collected from patients, and the mNUTRIC score, PALBI score and PNI were calculated. Univariate and multivariate Logistic regression were used to analyze the influencing factors of death in patients with cirrhosis complicated with UGIB, and receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of mNUTRIC score, PALBI score complicated with PNI on the risk of death in patients with cirrhosis complicated with UGIB. Results: Univariate analysis showed that compared with the survival group, Child-Pugh grading,blood transfusion volume, proportion of shock, proportion of ascites, proportion of hepatic encephalopathy, C-reactive protein, bilirubin,γ-glutamyltransferase, alkaline phosphatase, glutamic-oxalacetic transaminase, alanine transaminase, i Lymphocyte count, mNUTRIC score and PALBI score were higher in the death group. Mean arterial pressure, albumin, lymphocyte count and PNI were lower(P<0.05).Multivariate Logistic regression analysis showed that Child-Pugh grading C grade, increased blood transfusion volume, shock, ascites,hepatic encephalopathy, increased bilirubin, mNUTRIC score(higher), PALBI score(higher) were the risk factors for death in patients with cirrhosis complicated with UGIB. PNI(higher) was a protective factor(P<0.05). ROC curve analysis showed that the area under curve(AUC) of mNUTRIC score, PALBI score and PNI in combination with mNUTRIC score were 0.845, 0.817, 0.771 and 0.942,respectively. The AUC of mNUTRIC score, PALBI score and PNI combined to predict the risk of death in patients with cirrhosis complicated with UGIB was greater than that predicted alone. Conclusion: Child-Pugh grading, blood transfusion volume, shock, ascites, hepatic encephalopathy, bilirubin, mNUTRIC score, PALBI score and PNI are the influencing factors for the prognosis of patients with cirrhosis complicated with UGIB, and mNUTRIC score, PALBI score and PNI have a high clinical value in predicting the death risk of patients with cirrhosis complicated with UGIB.