慢加急性肝衰竭患者90 d预后模型的构建

摘要/Abstract

摘要： 目的探讨慢加急性肝衰竭(ACLF)预后的影响因素并构建预测模型。方法纳入2016年6月至2019年12月南京市第二医院收治的ACLF患者190例。随访90 d,根据预后情况将其分为死亡组89例和生存组101例。采用logistic 回归分析ACLF患者90 d预后的影响因素,构建预后模型。绘制ROC曲线评估模型的预测效能。结果多因素 logistic 回归分析结果显示,ACLF患者90 d预后的影响因素分别是年龄(OR=1.045,P=0.007)、肝性脑病(HE)(OR=4. 341,P<0.001)、凝血酶原时间(PT)(OR=1.241,P=0.001)、凝血酶原活动度(PTA)(OR=1.097,P=0.009)和国际标准化比值(INA)(OR=0.532,P=0.027)。模型方程为:NEWM=-72.662+0.044×年龄+0.216×PT+0.093×PTA-0.631×INR+1.468×HE。ROC曲线分析表明:该模型的AUC为0.81(95% CI: 0. 74 ~ 0.87)明显高于MELD评分0.67(95% CI: 0.59 ~ 0.74)、MELD-Na评分0.65(95% CI: 0. 57 ~ 0.73)、iMELD评分0.70(95% CI: 0. 62 ~ 0.77)和MESO评分0.66(95% CI: 0. 58 ~ 0.74),NEWM评分对ACLF患者90 d生存情况的预测能力明显优于其他评分。结论与MELD系列评分相比,NEWM对ACLF 患者预后判断效能最佳。

关键词: 慢加急性肝衰竭, 预后模型, 危险因素

Abstract: Objective To investigate the prognostic factors and prognosis mode in acute-on-chronic liver failure (ACLF). Methods A retrospective study was conducted and included clinical data from 190 patients diagnosed with ACLF between June 2016 and December 2019. Patients were followed up for 90 days and were stratified by prognosis into 89 cases (44.5%) in the death group and 101 cases (50.5%) in the survival group. Logistic regression was used to investigate the prognostic factors influencing the 90-day prognosis of ACLF patients and to construct a new prognostic model. The predictive performance of the model was assessed by plotting the ROC curve. Results The results of multivariate logistic regression analysis suggested that the independent predictors affecting the 90-day prognosis of ACLF patients were age(OR=1.045,P=0.007), HE(OR=4. 341,P＜0.001), PT( OR=1.241,P=0.001), PTA( OR=1.097,P=0.009) and INR( OR=0.532,P=0.027) ( P<0.05). The equation of the new model was : NEWM=-72.662 + 0.044 × age + 0.216 × PT + 0.093 × PTA-0.631 × INR + 1.468 × HE, and the ROC curve analysis showed that the AUC value of this model was 0.81( 95% CI: 0. 74 ~ 0.87) significantly higher than the MELD score of 0.67( 95% CI: 0.59 ~ 0.74), MELD-Na score 0.65( 95% CI:0. 57 ~ 0.73), iMELD score 0.70(95% CI:0. 62 ~ 0.77) and MESO score 0.66( 95% CI:0. 58 ~ 0.74), and the NEWM score had a significantly better predictive ability of 90-day survival in patients with ACLF than other scores. Conclusion Compared to the previous MELD series of scores, the NEWM is a simple and effective tool for predicting the prognosis of patients with ACLF.

Key words: Acute-on-chronic liver failure, Prognostic model, Risk factors

许景, 杨永峰. 慢加急性肝衰竭患者90 d预后模型的构建[J]. 肝脏, 2025, 30(4): 532-536.

XU Jing, YANG Yong-feng. Construction of a 90-day prognostic model with acute-on-chronic liver failure[J]. Chinese Hepatolgy, 2025, 30(4): 532-536.

/ 推荐

参考文献

[1] 中华医学会感染病学分会肝衰竭与人工肝学组,中华医学会肝病学分会重型肝病与人工肝学组. 肝衰竭诊治指南(2018年版)[J]. 临床肝胆病杂志, 2019,35(01):38-44.
[2] Hernaez R, Li H, Moreau R, et al. Definition, diagnosis and epidemiology of acute-on-chronic liver failure[J]. Liver Int, 2023.
[3] 中国中西医结合学会, 中华中医药学会, 中华医学会. 慢加急性肝衰竭中西医结合诊疗指南[J]. 临床肝胆病杂志, 2023,39(7):1547-1552.
[4] 林建辉, 陈丽霞, 刘海钰. 慢加急性乙型肝炎肝衰竭患者合并肝性脑病的相关因素分析[J]. 胃肠病学和肝病学杂志, 2024,33(12):1656-1660.
[5] Arroyo V, Moreau R, Jalan R. Acute-on-Chronic Liver Failure[J]. N Engl J Med, 2020,382(22):2137-2145.
[6] 黄洁婕, 蓝婧, 姚朝光, 等. 基于贝叶斯网络模型分析乙型肝炎合并非酒精性脂肪肝患者中乙型肝炎病毒滴度与慢加急性肝衰竭发生的关系[J]. 中国感染与化疗杂志, 2023,23(02):173-180.
[7] Ngu N L Y, Flanagan E, Bell S, et al. Acute-on-chronic liver failure: controversies and consensus[J]. World J Gastroenterol, 2023,29(2):232-240.
[8] Della Guardia B, Boteon A P C S, Matielo C E L, et al. Current and future perspectives on acute-on-chronic liver failure: Challenges of transplantation, machine perfusion, and beyond[J]. World J Gastroenterol, 2022,28(48):6922-6934.
[9] Mezzano G, Juanola A, Cardenas A, et al. Global burden of disease: acute-on-chronic liver failure, a systematic review and meta-analysis[J]. Gut, 2022,71(1):148-155.
[10] Sarin S K, Choudhury A, Sharma M K, et al. Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update[J]. Hepatol Int, 2019,13(4):353-390.
[11] Shen Y, Liu Y, Wang B, et al. External validation and comparison of six prognostic models in a prospective cohort of HBV-ACLF in China[J]. Ann Hepatol, 2016,15(2):236-245.
[12] Biggins S W, Kim W R, Terrault N A, et al. Evidence-based incorporation of serum sodium concentration into MELD[J]. Gastroenterology, 2006,130(6):1652-1660.
[13] Zhang Y, Luo Q, Lin X, et al. Development and validation of a new model including inflammation indexes for the long-term prognosis of hepatitis B-related acute-on-chronic liver failure[J]. J Med Virol, 2024,96(12):e70110.
[14] Yu Z, Zhang Y, Cao Y, et al. A dynamic prediction model for prognosis of acute-on-chronic liver failure based on the trend of clinical indicators[J]. Sci Rep, 2021,11(1):1810.
[15] Tan J, He Y, Li Z, et al. Analysis of the dose-response relationship between the international normalized ratio and hepatic encephalopathy in patients with liver cirrhosis using restricted cubic spline functions[J]. Front Public Health, 2022,10:919549.
[16] Wang L, Zhu S, Liu Y, et al. Prognostic value of decline in model for end-stage liver disease score and hepatic encephalopathy in hepatitis B-related acute-on-chronic liver failure patients treated with plasma exchange[J]. Scand J Gastroenterol, 2022,57(9):1089-1096.
[17] Li J, Liang X, You S, et al. Development and validation of a new prognostic score for hepatitis B virus-related acute-on-chronic liver failure[J]. J Hepatol, 2021,75(5):1104-1115.
[18] 赵紫烟, 安雪青, 史丽, 等. 血清前白蛋白/总胆红素比值对肝衰竭患者预后的预测价值[J]. 中国现代医学杂志, 2017,27(21):75-78.
[19] 窦侠玲, 庄玉, 周秋. 慢加急性肝衰竭患者短期预后预测模型的构建与验证[J]. 当代护士, 2024,31(5):138-142.
[20] Shen Y, Xu W, Chen Y, et al. Early prediction of acute-on-chronic liver failure development in patients with diverse chronic liver diseases[J]. Sci Rep, 2024,14(1):28245.
[21] 李琴,贾继东,王宝恩. 凝血酶原时间及凝血因子在肝病中的应用[J]. 中华肝脏病杂志, 2004(12):69-70.
[22] Lu J, Tu Z, Zhang Z, et al. The rate of change in clinical indicators can predict the progression of hepatitis B virus-related acute-on-chronic preliver failure[J]. Medicine (Baltimore), 2024,103(43):e40246.
[23] 徐曼曼, 孔明, 曹影影, 等. 慢加急性肝衰竭分型新视点:基于临床转归的动态分型新标准[J]. 中华肝脏病杂志, 2020,28(4):319-325.
[24] 刘叶莹, 王婷, 窦爱华, 等. 肝衰竭预后相关标志物的应用现状与展望[J]. 临床肝胆病杂志, 2019,35(05):1135-1139.
[25] 刘勇钢, 卢建华, 闫会敏, 等. HBV相关慢加急性肝衰竭预后评估模型的建立与验证[J]. 天津医药, 2021,49(9):981-986.