血尿素在慢加急性肝衰竭患者预后评估中的临床应用价值分析

目的探讨血尿素在慢加急性肝衰竭患者早期预后评估中的临床应用价值。方法回顾性收集2022年1~11月本院收治的慢加急性肝衰竭患者的临床资料。根据患者不同预后分为预后良好组和预后不佳组。分析两组患者确诊慢加急性肝衰竭时的血尿素水平差异,相关性分析血尿素与总胆红素、国际标准化比值、终末期肝病模型评分的相关性。绘制患者工作特征曲线评估血尿素水平的预后评估价值。结果本研究共入组115例慢加急性肝衰竭患者,其中预后良好组70例,预后不佳组45例。预后不佳组患者血尿素高于预后良好组[3.65(2.80,4.68)和5.90(4.00,7.30)mmol/L,Z=-4.618,P<0.001],Spearman秩相关性分析提示尿素水平与总胆红素(r=0.544,P<0.001)、国际标准化比值(r=0.547,P<0.001)、终末期肝病模型评分(r=0.521,P<0.001)均呈正相关。血尿素水平预测慢加急性肝衰竭患者预后的受试者工作特征曲线曲线下面积(AUC)是0.731,最佳截断值是4.85,灵敏度是0.867,特异度是0.529,具有良好预测价值。结论血尿素水平对慢加急性肝衰竭患者的早期预后判断具有较高的临床价值。

Objective To explore the clinical utility of blood urea in the early prognosis evaluation of patients with the acute-on-chronic liver failure(ACLF).Methods The clinical datas of patients with ACLF admitted to Hangzhou Xixi hospital from January 2022 to November 2022 were collected retrospectively.A total of 115 patients were enrolled in this study,including 70 patients in the good prognosis group and 45 patients in the poor prognosis group.The difference in blood urea levels in the diagnosis of ACLF between the two groups,and the correlation between blood urea and total bilirubin,international standardized ratio,and model score of end-stage liver disease were analyzed.The prediction performance was evaluated using a receiver operating characteristic(ROC)curve.Results Blood urea was higher in the group with poor prognosis than in the group with good prognosis[3.65(2.80,4.68)and 5.90(4.00,7.30)mmol/L,Z=-4.618,P<0.001].Spearman Rank correlation analysis suggested that urea levels was positively associated with total bilirubin(r=0.544,P<0.001),international standardized ratio(r=0.547,P<0.001)and the model scores for end-stage liver disease(r=0.521,P<0.001).The area under the ROC curve(AUC)of the blood urea was 0.731,the optimal cut-off value for the blood urea was 4.85,sensitivity was 0.867,and specificity was 0.529.Conclusion The blood urea levels has a higher clinical value in judging the short-term prognosis of patients with ACLF.