血小板-白蛋白-胆红素指数(PALBI)联合AIMS65评分对肝硬化并发急性上消化道出血患者短期预后的预测价值

Value of platelet-albumin-bilirubin index combined with AIMS65 score in predicting the short-term prognosis of patients with liver cirrhosis and acute upper gastrointestinal bleeding

目的探讨血小板-白蛋白-胆红素指数(PALBI)联合AIMS65评分对肝硬化并发急性上消化道出血(AUGIB)患者入院后6周内再出血及死亡的预测价值。方法选取2021年2月—2022年10月在锦州医科大学附属第一医院住院治疗的肝硬化并发AUGIB患者238例,所有纳入患者均随访6周,根据预后情况分为死亡组(n=65)和生存组(n=173)、未再出血组(n=149)和再出血组(n=89)。收集患者的一般资料及实验室指标(血常规,肝、肾功能及凝血指标等),计算入院时的PALBI评分、AIMS65评分、Child-Turcotte-Pugh(CTP)评分、终末期肝病模型(MELD)评分。计量资料两组间比较采用成组t检验或Mann-Whitney U检验;计数资料两组间比较采用χ2检验。采用多因素Logistic回归模型分析肝硬化并发AUGIB患者入院治疗后6周内死亡或再出血的危险因素。通过受试者工作特征曲线(ROC曲线)及曲线下面积(AUC)评估各评分系统的预测效能;AUC的比较采用DeLong检验。结果死亡组和生存组患者比较,呕血、既往有静脉曲张病史、Alb、TBil、INR、Cr、PT、收缩压、PALBI评分、AIMS65评分、CTP评分和MELD评分差异均有统计学意义(P值均<0.05);多因素Logistic回归分析结果显示,呕血(OR=4.34,95%CI:1.88~10.05,P<0.001)、既往有静脉曲张病史(OR=3.51,95%CI:1.37~8.98,P=0.009)、PALBI评分(OR=4.49,95%CI:1.48~13.64,P=0.008)及AIMS65评分(OR=3.85,95%CI:2.35~6.30,P<0.001)是患者死亡的独立危险因素;各评分预测生存情况的ROC曲线结果显示,CTP评分、MELD评分、PALBI评分、AIMS65评分、PALBI联合AIMS65评分的AUC分别为0.758、0.798、0.789、0.870、0.888,其中PALBI联合AIMS65评分的AUC明显高于4种评分单独预测的AUC(P值均<0.05)。再出血组和未再出血组患者比较,呕血、糖尿病病史、Alb、TBil、INR、Cr、PT、PALBI评分、AIMS65评分、CTP评分和MELD评分差异均有统计学意义(P值均<0.05);多因素Logistic回归分析结果显示,PALBI评分(OR=2.41,95%CI:1.17~4.95,P=0.017)和AIMS65评分(OR=1.58,95%CI:1.17~2.15,P=0.003)是患者再出血的独立危险因素;各评分预测再出血的ROC曲线结果显示,CTP评分、MELD评分、PALBI评分、AIMS65评分、PALBI联合AIMS65评分的AUC分别为0.680、0.719、0.709、0.711、0.741,PALBI联合AIMS65评分的AUC最大(P值均<0.05),但特异度较低。结论PALBI评分联合AIMS65评分对肝硬化并发AUGIB患者入院后6周内的死亡具有一定的预测价值,优于CTP评分及MELD评分单独检测;对6周内再出血预测价值较低,准确性一般。

Objective To investigate the value of platelet-albumin-bilirubin index(PALBI)combined with AIMS65 score in predicting rebleeding and death within 6 weeks after admission in patients with liver cirrhosis and acute upper gastrointestinal bleeding(AUGIB).Methods A retrospective study was conducted for 238 patients with liver cirrhosis and AUGIB who were hospitalized in The First Affiliated Hospital of Jinzhou Medical University from February 2021 to October 2022,and all patients were followed up for 6 weeks.According to the prognosis,they were divided into death group with 65 patients and survival group with 173 patients,and according to the presence or absence of rebleeding,they were divided into non-rebleeding group with 149 patients and rebleeding group with 89 patients.General data and laboratory markers(including blood routine,liver/renal function,and coagulation),and PALBI,AIMS65 score,Child-Turcotte-Pugh(CTP)score,and Model for End-stage Liver Disease(MELD)score were calculated on admission.The independent-samples t test or the Mann-Whitney U test was used for comparison of continuous data between two groups,and the chi-square test was used for comparison of categorical data between two groups.A multivariate logistic regression model analysis was used to investigate the risk factors for death or rebleeding within 6 weeks after admission in patients with liver cirrhosis and AUGIB.The receiver operating characteristic(ROC)curve and the area under the ROC curve(AUC)were used to investigate the predictive efficacy of each scoring system,and the DeLong test was used for comparison of AUC.Results There were significant differences between the death group and the survival group in hematemesis,past history of varices,albumin(Alb),total bilirubin(TBil),international normalized ratio(INR),creatinine(Cr),prothrombin time(PT),systolic blood pressure,PALBI,AIMS65 score,CTP score,and MELD score(all P<0.05).The multivariate logistic regression analysis showed that hematemesis(odds ratio[OR]=4.34,95%confidence interval[CI]:1.88—10.05,P<0.001),past history of varices(OR=3.51,95%CI:1.37—8.98,P=0.009),PALBI(OR=4.49,95%CI:1.48—13.64,P=0.008),and AIMS65 score(OR=3.85,95%CI:2.35—6.30,P<0.001)were independent risk factors for death.The ROC curve analysis of each scoring system in predicting survival showed that CTP score,MELD score,PALBI,AIMS65 score,and PALBI combined with AIMS65 score had an AUC of 0.758,0.798,0.789,0.870,and 0.888,respectively,suggesting that PALBI combined with AIMS65 score had a significantly larger AUC than the four scoring systems used alone(all P<0.05).There were significant differences between the rebleeding group and the non-rebleeding group in hematemesis,history of diabetes,Alb,TBil,INR,Cr,PT,PALBI,AIMS65 score,CTP score,and MELD score(all P<0.05).The multivariate logistic regression analysis showed that PALBI(OR=2.41,95%CI:1.17—4.95,P=0.017)and AIMS65 score(OR=1.58,95%CI:1.17—2.15,P=0.003)were independent risk factors for rebleeding.The ROC curve analysis of each scoring system in predicting rebleeding showed that CTP score,MELD score,PALBI,AIMS65 score,and PALBI combined with AIMS65 score had an AUC of 0.680,0.719,0.709,0.711,and 0.741,respectively,suggesting that PALBI combined with AIMS65 score had the largest AUC(all P<0.05),but with a relatively low specificity.Conclusion PALBI combined with AIMS65 score has a certain value in predicting death within 6 weeks after admission in patients with liver cirrhosis and AUGIB,with a better value than CTP score and MELD score alone.PALBI combined with AIMS65 score has a relatively low value in predicting rebleeding within 6 weeks,with an acceptable accuracy.