慢加急性乙型肝炎肝衰竭患者死亡危险因素和预后评分模型的构建

doi:10.3969/j.issn.1672-5069.2021.03.022

摘要/Abstract

摘要： 目的分析慢加急性乙型肝炎肝衰竭(HBV-ACLF)患者死亡的危险因素,建立预后评分预测模型。方法 2016年1月～2019年9月我院收治的126例HBV-ACLF患者,记录临床资料,将各指标纳入多因素Logistic回归分析,并建立预后评分预测模型,采用Hosmer-Lemeshow检验评估模型拟合度,采用ROC检验模型的预测价值。结果在90 d,本组HBV-ACLF患者死亡49例(38.9%);多因素分析显示血清总胆红素、外周血红细胞分布宽度(RDW)、凝血酶原时间国际标准化比值(INR)和存在并发症是影响HBV-ACLF患者死亡的独立危险因素;建立预后评分预测模型表达公式为P=1/[1+e^{(1.441×(TBIL)+1.385×(RDW)+0.983×(INR)+1.639×并发症-4.449)}],经Hosmer-Lemeshow检验,提示模型与观察值拟合度较好(x²=9.055,P=0.338),预后评分预测模型预测死亡的AUC为0.822,95%CI为0.749～0.894,预测效能较好。结论建立HBV-ACLF患者死亡预测模型有助于临床判断预后,及早作出正确的处置。

关键词: 慢加急性肝衰竭, 乙型肝炎, 预后, 危险因素, 评分模型

Abstract: Objective The aim of this study was to explore the risk factors of death and the construct a prognosis prediction model in patients with hepatitis B virus-related acute on chronic liver failure (HBV-ACLF). Methods 126 patients with HBV-ACLF were admitted to our hospital between January 2016 and September 2019,and their clinical materials were recorded. The multivariate Logistic regression was applied to set up a prediction model. The model fit was evaluated by Hosmer-Lemeshow test, and the predictive value of the model was verified by ROC curves. Results At the end of 90 days, 49 patients(38.9%) in our series died; the multivariate Logistic analysis showed that total serum bilirubin levels, red blood cell distribution width (RDW),INR) and with complications were the independent risk factors impacting the prognosis; the Hosmer-Lemeshow test demonstrated the formula, P=1/[1+e^{(1.441×(TBIL)+1.385×(RDW)+0.983×(INR)+1.639×complications-4.449)}] we established, goodness-of-fit (x²=9.055, P=0.338), and the AUC of the model was 0.822, with the 95%CI of 0.749-0.894.Conclusion We successfully set up a formula to predict the prognosis of patients with HBV-ACLF, which might guide the clinicians to make up a correct decision early.

Key words: Acute on chronic liver failure, Hepatitis B, Risk factors, Prognosis, Prognostic model

苏亚勇, 徐成润, 郭永木, 张惠勇, 刘双平, 陈小兰. 慢加急性乙型肝炎肝衰竭患者死亡危险因素和预后评分模型的构建[J]. 实用肝脏病杂志, 2021, 24(3): 391-394.

Su Yayong, Xu Chengrun, Guo Yongmu, et al. Risk factors of death in patients with hepatitis B virus-related acute on chronic liver failure[J]. Journal of Practical Hepatology, 2021, 24(3): 391-394.

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