Comparison of four prognostic models and a new Logistic regression model to predict short-term prognosis of acute-on-chronic hepatitis B liver failure

HE Wei-ping; HU Jin-hua; ZHAO Jun; TONG Jing-jing; DING Jin-biao; LIN Fang; WANG Hui-fen

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Comparison of four prognostic models and a new Logistic regression model to predict short-term prognosis of acute-on-chronic hepatitis B liver failure

机译：比较四种预后模型和新的Logistic回归模型以预测急性慢性乙型肝炎肝衰竭的短期预后

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Background Acute-on-chronic hepatitis B liver failure (ACLF-HBV) is a clinically severe disease associated with major life-threatening complications including hepatic encephalopathy and hepatorenal syndrome.The aim of this study was to evaluate the short-term prognostic predictability of the model for end-stage liver disease (MELD),MELD-based indices,and their dynamic changes in patients with ACLF-HBV,and to establish a new model for predicting the prognosis of ACLF-HBV.Methods A total of 172 patients with ACLF-HBV who stayed in the hospital for more than 2 weeks were retrospectively recruited.The predictive accuracy of MELD,MELD-based indices,and their dynamic change (△) were compared using the area under the receiver operating characteristic curve method.The associations between mortality and patient characteristics were studied by univariate and multivariate analyses.Results The 3-month mortality was 43.6％.The largest concordance (c) statistic predicting 3-month mortality was the MELD score at the end of 2 weeks of admission (0.8),followed by the MELD:sodium ratio (MESO) (0.796) and integrated MELD (iMELD) (0.758) scores,△MELD (0.752),△MESO (0.729),and MELD plus sodium (MELD-Na) (0.728) scores.In multivariate Logistic regression analysis,the independent factors predicting prognosis were hepatic encephalopathy (OR=-3.466),serum creatinine,international normalized ratio (INR),and total bilirubin at the end of 2 weeks of admission (OR=10.302,6.063,5.208,respectively),and cholinesterase on admission (OR=0.255).This regression model had a greater prognostic value (c=0.85,95％ Cl 0.791-0.909) compared to the MELD score at the end of 2 weeks of admission (Z=4.9851,P=-0.0256).Conclusions MELD score at the end of 2 weeks of admission is a useful predictor for 3-month mortality in ACLF-HBV patients.Hepatic encephalopathy,serum creatinine,international normalized ratio,and total bilirubin at the end of 2 weeks of admission and cholinesterase on admission are independent predictors of 3-month mortality.

机译：背景慢性乙型肝炎急性肝衰竭（ACLF-HBV）是一种临床严重疾病，伴有严重的危及生命的并发症，包括肝性脑病和肝肾综合征。本研究的目的是评估肝癌的短期预后可预测性。终末期肝病（MELD）模型，基于MELD的指标及其在ACLF-HBV患者中的动态变化，并建立新的预测ACLF-HBV患者预后的模型。方法共有172例ACLF患者回顾性研究入院2周以上的-HBV。使用受试者工作特征曲线法下的面积比较MELD，MELD指标的预测准确性及其动态变化（△）。结果：3个月死亡率为43.6％。最大预测3个月死亡率的一致性（c）为ME，3个月死亡率为43.6％。入院2周结束时的LD分数（0.8），其次是MELD：钠比（MESO）（0.796）和综合MELD（iMELD）（0.758）分数，△MELD（0.752），△MESO（0.729），在多元Logistic回归分析中，预测预后的独立因素是肝性脑病（OR = -3.466），血清肌酐，国际标准化比值（INR）和总胆红素。入院2周后（分别为OR = 10.302、6.063、5.208）和入院时胆碱酯酶（OR = 0.255）。该回归模型的预后价值较高（c = 0.85,95％Cl 0.791-0.909）入院2周末的MELD评分（Z = 4.9851，P = -0.0256）。结论入院2周末的MELD评分是ACLF-HBV患者3个月死亡率的有用预测指标。入院2周时的血清肌酐，国际标准化比率和总胆红素与入院时胆碱酯酶是独立的3个月死亡率的冰霜。

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《中华医学杂志（英文版）》 |2012年第13期|2272-2278|共7页
作者
HE Wei-ping; HU Jin-hua; ZHAO Jun; TONG Jing-jing; DING Jin-biao; LIN Fang; WANG Hui-fen;
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Liver Failure Therapy and Research Centre, 302 Hospital of People's Liberation Army, Beijing 100039, China;

Liver Failure Therapy and Research Centre, 302 Hospital of People's Liberation Army, Beijing 100039, China;

Liver Failure Therapy and Research Centre, 302 Hospital of People's Liberation Army, Beijing 100039, China;

Liver Failure Therapy and Research Centre, 302 Hospital of People's Liberation Army, Beijing 100039, China;

Liver Failure Therapy and Research Centre, 302 Hospital of People's Liberation Army, Beijing 100039, China;

Liver Failure Therapy and Research Centre, 302 Hospital of People's Liberation Army, Beijing 100039, China;

Liver Failure Therapy and Research Centre, 302 Hospital of People's Liberation Army, Beijing 100039, China;

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Comparison of four prognostic models and a new Logistic regression model to predict short-term prognosis of acute-on-chronic hepatitis B liver failure

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