关键词: 慢加急性肝衰竭, 预测模型, 动态变化, 回顾性队列研究

Abstract: Objective To investigate the clinical significance of the short-term dynamic changes of the new COSSH score (COSSH-ACLFⅡs) in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). Methods This is a retrospective cohort study with 99 HBV-ACLF patients who were admitted in Lanzhou Second People's Hospital., The general characteristics, 48hr, 3~7 d laboratory examination index, 28 d and 90 d prognosis were recorded, and the prognosis score at admission, 48 hr and 3~7 d COSSH-ACLFⅡs score were calculated, respectively. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) were used to evaluate the predictive value of each scoring model on the short-term prognosis of the studied patients. The clinical predictive value of the short-term dynamic changes of COSSH-ACLFⅡs in HBV-ACLF was analyzed by classified variables. Results The largest AUC of COSSH-ACLFIIs to predict the 28d and 90d deaths of patients had the highest sensitivity and specificity (75% vs. 84% and 86.8% vs. 80.9%, respectively). The COSSH-ACLFIIs resolved or improved in 35.86% of patients, had a steady or fluctuating course in 42.4% and worsened in 21.7% of patients. In the improvement group, 87.8% of patients survived, while in the deterioration group, 85.0% of patients died. Conclusion In comparison with MELD, MELD-Na, CLIF-COFs, and CLIF-CACLFs, COSSH-ACLFIIs has higher sensitivity and specificity for predicting HBV-ACLF. The Survival of 3~7d can be accurately predicted after evaluation with COSSH-ACLFIIs.

Key words: Acute-on-chronic liver failure, Prediction model, Dynamic change, Retrospective cohort study