肝体积联合血小板在评估慢加急性肝衰竭预后中的应用

Study on the prognosis of chronic acute hepatic failure patients based on the prediction model of liver vol⁃ume and platelet

目的探讨肝体积(liver volume,LV)与估计肝体积(estimated liver volume,ELV)比率(LV/ELV%)联合血小板(platelet,PLT)在评估慢加急性肝衰竭(acute⁃on⁃chronic liver failure,ACLF)患者的预后价值。方法回顾性分析2020年1月至2022年8月医院诊治且入院后3 d内行腹部CT检查的76例ACLF患者的临床资料,按照入院后90 d的预后情况分为生存组和死亡组,分析LV/ELV%与PTA、ACLF预后模型的相关性。通过多因素logistic回归方法分析影响ACLF患者预后的危险因素,并建立LV/ELV%联合PLT的预测模型;ROC曲线分析LV/ELV%、血小板单独及联合的临床效能;计算LV/ELV%联合PLT预测ACLF预后的最佳临界值,Kaplan⁃Meier法绘制生存曲线。结果两组患者TBIL、INR、PTA、PLT、LV、LV/ELV%、CTP、MELD和iMELD评分比较差异均有统计学意义(P<0.05)。Pearson相关分析显示LV/ELV%与PTA(r=0.4823,P<0.001)呈正相关,与CTP评分(r=-0.3437,P=0.0024)、MELD评分(r=-0.3109,P=0.0063)及iMELD评分(r=-0.3022,P=0.0080)呈负相关(P<0.05)。多因素分析显示LV/ELV%(0R=0.965,95%CI:0.941~0.991,P=0.007)和PLT(0R=0.986,95%CI:0.975~0.998,P=0.020)是影响ACLF患者预后的独立危险因素。LV/ELV%联合PLT的ROC曲线下面积(area under the ROC curve,AUC)最大(AUC=0.83,95%CI:0.73~0.92),高于单独LV/ELV%(AUC=0.79,95%CI:0.68~0.90)和PLT(AUC=0.69,95%CI:0.57~0.81)。LV/ELV%联合PLT最佳临界值为0.63,Kaplan⁃Meier生存分析显示,LV/ELV%联合PLT<0.63的患者90 d生存率为78.18%(43/55),显著高于LV/ELV%联合PLT≥0.63组患者的9.52%(2/21),差异有统计学意义(P<0.0001)。结论LV/ELV%联合PLT可以提高单独LV/ELV%和PLT预测ACLF患者预后的预测效能;LV/ELV%联合PLT≥0.63组患者提示预后不良。

Objective To investigate the prognostic value of the ratio of liver volume(LV)to estimated liver volume(ELV)(LV/ELV%)combined with platelet(PLT)in patients with chronic acute liver failure(ACLF).Methods Retrospective analysis was made on the clinical data of 76 patients with ACLF who were diagnosed and treated by Nantong Third People′s Hospital from January 2020 to August 2022 and underwent abdominal CT exami⁃nation within 3 days after admission,The patients were divided into survival group and death group according to the prognosis of 90 days after admission,and the correlation between LV/ELV%and PTA,ACLF prognostic models was analyzed.Multivariate logistic regression was used to analyze the risk factors affecting the prognosis of patients with ACLF,and a prediction model of LV/ELV%combined with PLT was established;ROC curve was used to analyze the clinical efficacy of LV/ELV%and platelet alone and in combination;The optimal critical value of LV/ELV%combined with PLT for predicting the prognosis of ACLF was calculated,and the survival curve was drawn by Kaplan Meier method.Results The scores of TBIL,INR,PTA,PLT,LV,LV/ELV%,CTP,MELD and iMELD were significantly different between the two groups(P<0.05).Pearson correlation analysis showed that LV/ELV%was positively correlated with PTA(r=0.4823,P<0.001)and negatively correlated with CTP score(r=-0.3437,P=0.0024),MELD score(r=-0.3109,P=0.0063)and iMELD score(r=-0.3022,P=0.0080)(P<0.05).Multivariate analysis showed LV/ELV%(OR=0.965,95%CI:0.941~0.991,P=0.007)and PLT(OR=0.986,95%CI:0.975~0.998,P=0.020)were independent risk factors affecting the prognosis of patients with ACLF.The area under the ROC curve(AUC)of LV/ELV%combined PLT was the largest(AUC=0.83,95%CI:0.73~0.92),which was higher than the scores of LV/ELV%alone(AUC=0.79,95%CI:0.68~0.90)and PLT(AUC=0.69,95%CI:0.57~0.81).The optimal critical value of LV/ELV%combined with PLT was 0.63.Kaplan Meier survival analysis showed that the 90 day survival rate of patients with LV/ELV%combined with PLT<0.63 was 78.18%(43/55),which was significantly higher than that of patients with LV/ELV%combined with PLT≥0.63(9.52%(2/21),and the difference was statistically significant(P<0.0001).Conclusion LV/ELV%combined with PLT can improve the predictive efficacy of LV/ELV%and PLT alone in predicting the prognosis of patients with ACLF:LV/ELV%combined with PLT≥0.63 group indicates poor prognosis.