系统性炎症反应指数对乙型病毒性肝炎相关慢加急性肝衰竭患者短期预后的预测价值

Values of the sysltemic inflammation response index in predicting short- term prognosis of patients with HBV-related acute-on-chronic liver failure

目的 评估全系统性炎症反应指数(SIRI)对乙型病毒性肝炎相关的慢加急性肝衰竭(HBV-ACLF)患者预后的预测价值。方法 回顾性分析宁夏医科大学感染性疾病科2016年1月至2021年2月收治的149例HBV-ACLF患者的临床资料。收集患者一般资料和入院后首次实验室检查资料,根据90 d生存期,将患者分为生存组(93例)和死亡组(56例)。采用Cox回归模型对HBV-ACLF患者90 d预后进行单因素和多因素预测分析。通过受试者工作特征(ROC)分析及Delong test,评估SIRI对HBV-ACLF患者预后的预测能力。采用Kaplan-Meier分析计算高、低SIRI组之间的生存曲线;结果 死亡组HBV-ACLF患者的SIRI值高于生存组(P<0.001)。多因素Cox分析显示,SIRI和MELD评分是预测HBV-ACLF患者90 d病死率的独立危险因素。在预测HBV-ACLF患者的不良结局方面,SIRI的ROC曲线下面积(AUC)最大(0.850),预测性能高于其他外周血炎症标志物(单核细胞淋巴细胞比值、SII、PLR、CRP/L、RDW/PLT、NLPR)、MELD、MELD-Na和CTP评分。结论 SIRI指数对HBV-ALCF的预测价值明显高于其他外周血炎症标志物,可作为预测HBV-ACLF患者系统性炎症反应的标志物。

Objective To evaluate the predictive value of systemic inflammatory response index(SIRI)for prognosis in patients with acute on chronic liver failure(HBV-ACLF)related to hepatitis B.Methods A total of 149 patients diagnosed with HBV-ACLF were included in General Hospital of Ningxia Medical University,between Jan.2016 and Feb.2021.Their relevant clinical data were analyzed retrospectively.The general data and the first lab examination data after admission were collected.The patients were divided into the survival group(n=93)and non-survival group(n=56)on the basis of the 90 day survival ending.Univariate and multivariate analysis for predicting the 90-day prognosis of HBV-ACLF patients were performed by the Cox regression model.The predictive ability of SIRI to predict prognosis of HBV-ACLF patients was evaluated by the receiver operating characteristic(ROC)analysis and the Delong test.The curves of survival probability of high and low SIRI groups were calculated by the Kaplan-Meier analysis.Results In patients with HBV-ACLF,SIRI in non-survivors was higher than that in survivors(P<0.001).Multivariate Cox analysis indicated that SIRI and MELD scores were independent risk factors for predicting 90-day mortality in patients with HBV-ACLF.In predicting adverse outcomes in patients with HBV ACLF,SIRI had the largest area under the ROC curve(AUC),and its predictive value was higher than other peripheral blood inflammatory markers(MLR,SI,PLR,CRP/L,RDW/PLT,NLPR),MELD,MELD-Na,and CTP scores.Conclusions The predictive value of SIRI is remarkably higher than other peripheral inflammatory markers,which can be used as a marker to predict systematic inflammation response of HBV-ACLF patients.