CONUT联合CTP评分预测肝硬化合并肝性脑病患者短期预后的临床意义

Clinical Significance of CONUT Combined With CTP Score in Predicting Short⁃term Prognosis of Patients With Liver Cirrhosis Complicated With Hepatic Encephalopathy

背景:肝性脑病(HE)是终末期肝病患者的主要死因之一。早期评估肝硬化合并HE病情是改善患者预后的关键。目的:探讨控制营养状况(CONUT)联合CTP评分对肝硬化合并HE患者短期预后的影响。方法:回顾性分析2018年1月—2021年12月南通市第三人民医院初诊的168例肝硬化合并HE患者的临床资料,并分为生存组和死亡组。采用Cox回归分析评估影响预后的危险因素。建立新的预测模型,采用ROC曲线评价不同评分对HE患者短期预后的价值。采用Kaplan⁃Meier法评估患者生存情况。结果:死亡组ALT、AST、TBIL、INR、白细胞计数、中性粒细胞明显高于生存组(P<0.05),ALB、总胆固醇、血清钠、纤维蛋白原、淋巴细胞明显低于生存组(P<0.05)。CONUT(OR=1.499,95%CI:1.092~2.057,P=0.012)、CTP评分(OR=1.474,95%CI:1.178~1.844,P=0.001)是肝硬化合并HE患者90 d病死率的独立危险因素。CTP、CONUT、CONUT⁃CTP三种评分模型的AUC分别为0.90、0.94、0.95。Kaplan⁃Meier分析结果显示,CONUT⁃CTP评分≥7.50分组的生存率明显低于<7.50分组(P<0.0001)。结论:CONUT⁃CTP评分对肝硬化合并HE患者预后有良好的预测价值,≥7.50分提示患者预后不佳。

Background:Hepatic encephalopathy(HE)is one of the main causes of death in patients with end⁃stage liver disease.Early evaluation of the condition of patients with liver cirrhosis complicated with HE is the key for improving the prognosis.Aims:To investigate the effects of controlling nutritional status(CONUT)and CTP score on predicting the short⁃term prognosis of liver cirrhosis patients complicated with HE.Methods:The clinical data of 168 liver cirrhosis patients complicated with HE initially diagnosed in Nantong Third People's Hospital from January 2018 to December 2021 were enrolled and analyzed retrospectively.HE patients were divided into survival group and death group.Cox regression analysis was used to evaluate the risk factors affecting the prognosis.A new prediction model was established,and ROC curve was used to evaluate the values of different models for short⁃term prognosis of HE patients.Survival was evaluated by Kaplan⁃Meier method.Results:Compared with survival group,ALT,AST,TBIL,INR,white blood cell count,neutrophil were significantly increased in death group(P<0.05),while ALB,total cholesterol,serum Na,fibrinogen,lymphocyte were significantly decreased(P<0.05).CONUT(OR=1.499,95%CI:1.092⁃2.057,P=0.012),CTP score(OR=1.474,95%CI:1.178⁃1.844,P=0.001)were independent risk factors for 90⁃day mortality in liver cirrhosis patients complicated with HE.AUC of CTP,CONUT and CONUT⁃CTP scoring models were 0.90,0.94 and 0.95,respectively.Kaplan⁃Meier analysis showed that the survival rate in CONUT⁃CTP≥7.50 group was significantly lower than that in<7.50 group(P<0.0001).Conclusions:CONUT⁃CTP score has good predictive value for the prognosis of liver cirrhosis patients complicated with HE,CONUT⁃CTP≥7.50 indicates poor prognosis.