红细胞分布宽度与白蛋白比值联合INR对肝硬化并发肝性脑病的预测价值

Predictive value of red blood cell distribution width to albumin ratio combined with INR in cirrhosis complicated by hepatic encephalopathy

目的:探讨红细胞分布宽度/白蛋白比值(red blood cell distribution width/albumin ratio,RAR)联合国际标准化比值(international normalized ratio,INR)对肝硬化并发肝性脑病(hepatic encephalopathy,HE)预后的预测价值。方法:回顾性收集并分析2018年6月—2022年6月在南通市第三人民医院诊治的肝硬化并发HE患者160例的临床资料。依据90 d的预后情况,将患者分为生存组(109例)和死亡组(51例),比较两组患者的临床资料、实验室检查等指标,运用多因素Cox回归分析研究影响HE预后的相关因素,绘制ROC曲线,评估RAR联合INR对肝硬化并发HE的预测效能。结果:生存组与死亡组患者总胆红素、白蛋白、血清钠、INR、红细胞分度宽度、PLT计数、RAR、终末期肝病模型(model for end-stage liver disease,MELD)评分、Child-Turcotte-Pugh(CTP)评分、MELD-Na评分比较,差异均有统计学意义(均P<0.05)。对上述变量进行多因素Cox回归分析,显示RAR(OR=1.105,95%CI:1.051~1.161,P<0.001)和INR(OR=0.259,95%CI:0.069~0.965,P=0.044)是影响肝硬化并发HE患者短期预后的独立危险因素。ROC曲线分析结果表明,RAR、INR、RAR联合INR 3种评分模型的AUC分别为0.803、0.712、0.812。结论:RAR联合INR对肝硬化患者并发HE有较高的预测效能,可作为预测肝硬化并发HE的生物学指标。

Objective:To investigate the predictive value of the red blood cell distribution width/albumin ratio(RAR)combined with the international normalized ratio(INR)on the prognosis of cirrhosis complicated by hepatic encephalopathy(HE).Methods:The clinical data of 160 patients with cirrhosis complicated by hepatic encephalopathy treated at the Nantong Third People′s Hospital from June 2018 to June 2022 were retrospectively collected and analyzed.Based on the 90-day prognosis,the patients were divided into 109 cases in the survival group and 51 cases in the death group,and the clinical data,laboratory tests and other indicators of the two groups were compared.Cox regression was applied to analyze the relevant factors affecting the prognosis of hepatic encephalopathy,and ROC curves were drawn to assess the predictive efficacy of RAR combined with INR on cirrhosis complicated by hepatic encephalopathy.Results:Total bilirubin,albumin,serum sodium,INR,erythrocyte fractionation width,platelet count,RAR,model for end-stage liver disease(MELD)score,Child-Turcotte-Pugh(CTP)score,and MELD-Na score were statistically significant(all P<0.05)when comparing patients in the surviving group with those in the death group.Multifactorial Cox regression analysis of the above variables showed that RAR(OR=1.105,95%CI:1.051-1.161,P<0.001)and INR(OR=0.259,95%CI:0.069-0.965,P=0.044)were independent risk factors affecting the short-term prognosis of patients with cirrhosis complicated by hepatic encephalopathy.The results of ROC curve analysis showed that the AUC for the three scoring models of RAR,INR,and RAR combined with INR were 0.803,0.712,and 0.812,respectively.Conclusion:RAR combined with INR has high predictive efficacy in patients with cirrhosis complicated by hepatic encephalopathy,and can be used as a biological indicator to predict cirrhosis complicated by hepatic encephalopathy.