摘要
目的评估MELD、AARC、COSSH三种评分系统对乙型肝炎相关慢加急性肝衰竭(HBV-ACLF)患者90 d预后的预测价值。方法收集2017年7月-2019年5月在朝阳市中心医院住院治疗的88例HBV-ACLF患者的临床资料,根据入院后90 d随访结果分为生存组(n=35)和死亡组(n=53);对影响HBV-ACLF患者90 d预后的相关因素进行分析,并计算三种评分系统得分,评估三种评分系统的预测价值。符合正态分布的计量资料两组间比较采用t检验,非正态分布的计量资料两组间比较采用Mann-Whitney U检验,计数资料两组间比较采用χ2检验;采用多因素二元logistic回归分析影响HBV-ACLF预后的因素;绘制受试者工作特征曲线(ROC曲线),三组评分的ROC曲线下面积(AUC)两两比较采用Z检验。结果单因素分析结果显示:年龄、TBil、WBC、PLT、尿酸(SUA)、肌酐(Cr)、凝血酶原活度(PTA)、血清钠离子浓度(Na)、国际标准化比值(INR)、动脉血乳酸(Lac)、氧合指数(PaO2/FiO2)、并发症(肝性脑病、肺部感染、上消化道出血、肝肾综合征)发生率、MELD评分、COSSH评分、AARC评分两组间差异均有统计学意义(P值均<0.05)。多因素logistic分析发现TBil比值比(OR)=0.982,95%可信区间(95%CI:0.970~0.995,P=0.006)、Na(OR=1.168,95%CI:1.024~1.332,P=0.021)、Cr(OR=0.950,95%CI:0.906~0.996,P=0.033)、年龄(OR=0.910,95%CI:0.842~0.983,P=0.016)、PaO2/FiO2(OR=1.058,95%CI:1.028~1.089,P<0.001)是影响HBV-ACLF患者90 d预后的独立危险因素。ROC曲线分析结果显示,COSSH的曲线下面积(0.937)及Youden指数(0.820)均高于MELD、AARC评分(曲线下面积分别为0.836、0.816,Youden指数分别为0.574、0.497);COSSH评分曲线下面积明显高于AARC评分(Z=3.082,P<0.05)。结论三种评分系统对HBV-ACLF患者90 d预后均有较好的评估价值,COSSH评分可能具有更高的评估价值。
Objective To investigate the value of Model for End-Stage Liver Disease(MELD),APASL-ACLF Research Consortium(AARC),and Chinese Group on the Study of Severe Hepatitis B(COSSH)scoring systems in evaluating the 90-day prognosis of hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF).Methods A retrospective analysis was performed for the clinical data of 88 patients with HBV-ACLF who were hospitalized in Chaoyang Central Hospital from July 2017 to May 2019,and according to the follow-up results on day 90 after admission,the patients were divided into survival group with 35 patients and death group with 53 patients.The influencing factors for the 90-day prognosis of HBV-ACLF patients were analyzed;the above three scores were determined,and their predictive value was evaluated.The t-test was used for comparison of normally distributed continuous data between groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups;the chi-square test was used for comparison of categorical data between groups.A multivariate binary logistic regression analysis was used to investigate the influencing factors for the prognosis of HBV-ACLF.The receiver operating characteristic(ROC)curve was plotted,and the Z test was used for comparison of area under the ROC curve(AUC)between two scores.Results The univariate analysis showed that there were significant differences between the two groups in age,total bilirubin(TBil),white blood cell count,platelet count,uric acid,creatinine(Cr),prothrombin activity,serum sodium concentration(Na),international standardized ratio,arterial blood lactate,oxygenation index(PaO2/FiO2),complications(hepatic encephalopathy,pulmonary infection,upper gastrointestinal bleeding,and hepatorenal syndrome),MELD score,AARC score,and COSSH score(all P<0.05).The multivariate logistic regression analysis found that TBil(odds ratio[OR]=0.982,95%confidence interval[CI]:0.970-0.995,P=0.006),Na(OR=1.168,95%CI:1.024-1.332,P=0.021),Cr(OR=0.950,95%CI:0.906-0.996,P=0.033),age(OR=0.910,95%CI:0.842-0.983,P=0.016),and PaO2/FiO2(OR=1.058,95%CI:1.028-1.089,P<0.001)were independent influencing factors for the 90-day prognosis of patients with HBV-ACLF.The ROC curve analysis showed that COSSH score had significantly higher AUC and Youden index than MELD score(0.937/0.820 vs 0.836/0.574)and AARC score(0.937/0.820 vs 0.816/0.497),and COSSH score had a significantly higher AUC than AARC score(Z=3.082,P<0.05).Conclusion These three scoring systems have a good value in evaluating the 90-day prognosis of HBV-ACLF patients,and COSSH score may have a higher value than the other two scores.
作者
张文佳
赵丽娟
吴基洲
ZHANG Wenjia;ZHAO Lijuan;WU Jizhou(Graduate School, Jinzhou Medical University, Jinzhou, Liaoning 121000, China)
出处
《临床肝胆病杂志》
CAS
北大核心
2020年第4期813-817,共5页
Journal of Clinical Hepatology
