COSSH ACLF评分联合血清NLR、AFP对人工肝治疗慢加急性肝衰竭短期预后的预测价值

摘要/Abstract

摘要： 目的探讨COSSH ACLF评分联合血清中性粒细胞/淋巴细胞比值(NLR)、甲胎蛋白(AFP)对人工肝治疗慢加急性肝衰竭(ACLF)短期预后的预测价值。方法回顾性选取2020年2月—2022年1月在吉林大学第二医院成功接受人工肝治疗的ACLF患者260例,作为治疗组。基于患者治疗90 d后是否存活,将治疗组患者分为生存组236例和死亡组24例。另选取同期在我院进行健康体检的志愿者260例作为对照组。比较治疗组和对照组的COSSH ACLF评分、NLR和AFP。比较生存组和死亡组的COSSH ACLF评分、NLR和AFP。多因素logistics回归分析影响ACLF短期预后的危险因素。采用ROC曲线评估COSSH ACLF评分、NLR和AFP对人工肝治疗ACLF短期预后的预测价值。结果治疗组COSSH ACLF评分(6.32±0.57 vs. 1.03±0.20)、NLR(12.45±1.26 vs. 5.28±1.74)和AFP(89.24±7.38 vs. 20.45±3.46)均高于对照组(均P<0.05);死亡组COSSH ACLF评分(5.34±1.53 vs. 7.93±1.37)、NLR(10.37±1.24 vs. 14.29±2.04)和AFP(73.82±10.25 vs. 108.21±15.30)均高于生存组(均P<0.05);人工肝治疗ACLF短期预后与血清总胆红素(TBil)、肌酐(Cr)、国际标准化比值(INR)、终末期肝病模型(MELD)评分、C反应蛋白(CRP)、COSSH ACLF评分、NLR和AFP相关(均P<0.05);多因素回归分析表明,TBil、INR、COSSH ACLF评分、NLR、AFP为人工肝治疗ACLF短期预后的危险因素(均P<0.05)。ROC曲线显示,COSSH ACLF评分、NLR、AFP联合预测ACLF短期预后的AUC为0.877,大于单独预测的AUC,COSSH ACLF评分、NLR、AFP分别为0.733、0.798、0.794(P<0.05)。结论 COSSH ACLF评分、NLR和AFP是人工肝治疗ACLF短期预后的危险因素,其联合检测对患者的短期预后有一定的预测价值。

关键词: 人工肝, 慢加急性肝衰竭, COSSH ACLF评分, NLR, AFP, 短期预后

Abstract: Objective To investigate the predictive value of COSSH-ACLF score combined with serum neutrophil/lymphocyte ratio (NLR) and alpha-fetoprotein (AFP) in the short-term prognosis of acute-on-chronic liver failure (ACLF) after artificial liver support therapy. Methods 260 patients with ACLF who successfully received artificial liver support therapy in our hospital from February 2020 to January 2022 were selected retrospectively as the treatment group. Based on whether the patients survived 90 days after treatment, the patients in the treatment group were subdivided into survival group (236 cases) and death group (24 cases). In addition, 260 volunteers who underwent physical examination in our hospital at the same time were selected as the control group. COSSH-ACLF score, NLR and AFP levels were recorded for further analysis. Multivariate logistics regression analysis was used to analyze the risk factors affecting the short-term prognosis of ACLF. ROC curve was used to evaluate the predictive value of COSSH-ACLF score, NLR and AFP on the short-term prognosis of ACLF after artificial liver support therapy. Results The scores of COSSH-ACLF, NLR and AFP in the treatment group were higher than those in the control group (P<0.05); COSSH ACLF score, NLR and AFP in the death group were higher than those in the survival group (P<0.05); The short-term prognosis of ACLF after artificial liver therapy was correlated with serum total bilirubin (TBil), creatinine (Cr), international normalized ratio (INR), MELD score, C-reactive protein (CRP), COSSH-ACLF score, NLR and AFP (P<0.05); Multivariate regression analysis showed that TBil, INR, COSSH-ACLF score, NLR, AFP were the risk factors for short-term prognosis of ACLF treated with artificial liver support therapy (P<0.05). ROC curve showed that the combined prediction of COSSH-ACLF score, NLR, and AFP for short-term prognosis of ACLF had an AUC of 0.877, which was greater than the AUC of individual predictions (P<0.05), and AUC of COSSH ACLF score, NLR, AFP were 0.733, 0.798, 0.794, respectively. Conclusion COSSH ACLF score, NLR and AFP are risk factors for short-term prognosis of patients with ACLF after artificial liver support therapy, and their combined detection has certain predictive value for short-term prognosis of patients with ACLF.

Key words: Artificial liver, Acute-on-chronic liver failure, COSSH-ACLF score, NLR, AFP, Short-term prognosis

张雪, 宋洁, 邵雪. COSSH ACLF评分联合血清NLR、AFP对人工肝治疗慢加急性肝衰竭短期预后的预测价值[J]. 肝脏, 2023, 28(6): 702-706.

ZHANG Xue, SONG Jie, SHAO Xue. Predictive value of COSSH-ACLF score combined with serum NLR and AFP for short-term prognosis of acute-on-chronic liver failure after artificial liver support therapy[J]. Chinese Hepatolgy, 2023, 28(6): 702-706.

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