多种预后评分系统预测慢加急性肝衰竭并发真菌感染患者短期预后价值分析*

doi:10.3969/j.issn.1672-5069.2021.06.021

摘要/Abstract

摘要： 目的探讨应用终末期肝病模型(MELD)、终末期肝病模型联合血清钠模型(MELD-Na⁺)、亚太肝脏研究协会慢加急性肝衰竭研究小组评分(AARC-ACLF)和慢性肝衰竭-序贯器官衰竭评分(CLIF-SOFA)等4种预后评分系统预测慢加急性肝衰竭(ACLF)并发真菌感染(IFI)患者短期预后的价值。方法 2018年1月～2020年10月我院收治的ACLF并发IFI患者60例,给予内科综合治疗,分别计算MELD、MELD-Na⁺、AARC-ACLF和CLIF-SOFA评分,应用受试者工作特征曲线(ROC)评估4种预后评分系统对患者死亡风险的预测效能。结果在治疗观察12 w末,本组ACLF并发IFI患者病死率为68.3%;41例死亡组血清总胆红素、凝血酶原时间国际标准化比值、肌酐和乳酸水平分别为(362.9±79.7)μmol/L、(2.3±0.2)、(131.7±21.5)μmol/L和(1.6±0.4)mmol/L,均显著高于生存组【分别为(277.4±63.6)μmol/L、(1.7±0.1)、(102.9±15.3)μmol/L和(1.3±0.3)mmol/L,P＜0.05】,而血清白蛋白水平为(29.6±2.2)g/L,显著低于生存组【(31.8±2.7)g/L,P＜0.05】;死亡组并发肝性脑病发生率为43.9%,显著高于生存组的10.5%(P＜0.05);死亡组MELD评分、MELD-Na⁺评分、CLIF-SOFA评分和AARC-ACLF评分分别为(29.1±7.3)分、(30.4±7.5)分、(8.7±1.4)分和(9.2±1.1)分,均显著高于生存组【分别为(20.7±4.6)分、(21.9±5.2)分、(6.8±1.0)分和(7.3±0.8)分,P＜0.05】;ROC曲线分析发现,分别以MELD评分＞22.0分、MELD-Na⁺评分＞23.0分、AARC-ACLF评分＞8.0分和CLIF-SOFA评分＞8.0分为截断点,预测ACLF并发IFI患者12 w死亡风险高的AUC分别为0.687、0.716、0.893和0.884,提示CLIF-SOFA评分和AARC-ACLF评分预测效能显著优于MELD评分或MELD-Na⁺评分(P＜0.05)。结论应用AARC-ACLF和CLIF-SOFA评分可预测ACLF并发IFI患者近期病死风险,具有一定的临床实用价值。

关键词: 慢加急性肝衰竭, 真菌感染, 亚太肝脏研究协会慢加急性肝衰竭研究小组评分, 预后

Abstract: Objective The aim of this study was to explore the short-term prognosis of patients with acute on chronic liver failure (ACLF) and invasive fungal infection (IFI) by the model for end-stage liver disease (MELD), MELD-serum sodium (MELD-Na⁺), APASL-ACLF research consortium score (AARC-ACLF) and chronic liver failure-sequential organ failure assessment (CLIF-SOFA). Methods 60 patients with ACLF and IFI were admitted to our hospital between January 2018 and October 2020, and were given convensional supporting therapy. Thescores of MELD, MELD-Na⁺, AARC-ACLF and CLIF-SOFA were calculated. The predictive efficacy of the four prognostic scoring systems for death risk in patients with ACLF and IFI was evaluated by receiver operating characteristic (ROC) curves. Results At the end of 12 week treatment, the fatality rate in our series was 68.3%; serum bilirubin, INR, creatinine and lactate in 41 dead patients at the peak were (362.9±79.7)μmol/L,(2.3±0.2), (131.7±21.5)μmol/L and (1.6±0.4)mmol/L, all significantly higher than [(277.4±63.6)μmol/L, (1.7±0.1), (102.9±15.3)μmol/L and (1.3±0.3)mmol/L, respectively, P＜0.05], while serum albumin level was (29.6±2.2)g/L, significantly lower than [(31.8±2.7)g/L, P＜0.05] in the survivals; the incidence of hepatic encephalopathy was 43.9%, much higher than 10.5% (P＜0.05) in the survivals; the MELD, MELD-Na⁺, CLIF-SOFA and AARC-ACLF scores were (29.1±7.3), (30.4±7.5), (8.7±1.4) and (9.2±1.1), all significantly higher than [(20.7±4.6), (21.9±5.2),(6.8±1.0) and (7.3±0.8), respectively, P＜0.05] in the survivals; the ROC curves analysis showed that the AUC were 0.687, 0.716, 0.893 and 0.884 by MELD, MELD-Na⁺, CLIF-SOFA and AARC-ACLF scores, respectively, in predicting the 12-week death of patients with ACLF AND IFI, when the cut-off-value were set 22.0, 23.0, 8.0 and 8.0, suggesting the CLIF-SOFA and AARC-ACLF scoring system were superior to the other two (P＜0.05). Conclusion We recommend the AARC-ACLF and CLIF-SOFA scoring system in predicting the short-term fatality in patients with ACLF and IFI.

Key words: Acute on chronic liver failure, Invasive fungal infection, APASL-ACLF research consortium score, Prognosis

刘积庆, 于国英, 杨生森, 黄群, 保成兰. 多种预后评分系统预测慢加急性肝衰竭并发真菌感染患者短期预后价值分析^*[J]. 实用肝脏病杂志, 2021, 24(6): 851-854.

Liu Jiqing, Yu Guoying, Yang Shengsen, et al. Short-term prognosis of patients with acute on chronic liver failure and invasive fungal infection by four prognostic scoring systems[J]. Journal of Practical Hepatology, 2021, 24(6): 851-854.

参考文献

[1] Yang L, Wu T, Li J, et al. Artificial liver treatment improves survival in patients with hepatitis B virus-related acute-on-chronic liver failure: a case-control matched analysis. Hepatol Res, 2020,50(6):656-670.
[2] Spagnuolo MS, Bergamo P, Crescenzo R, et al. Brain Nrf2 pathway, autophagy, and synaptic function proteins are modulated by a short-term fructose feeding in young and adult rats. Nutr Neurosci, 2020,23(4):309-320.
[3] Yan Q, Wang L, Lai L, et al. Next generation sequencing reveals novel alterations in B-cell heavy chain receptor repertoires associated with acute-on-chronic liver failure. Int J Mol Med, 2019,43(1):243-255.
[4] 赵洁,李力,李秀惠, 等.乙型肝炎病毒相关慢加急性肝衰竭患者短期预后模型的建立及预测价值研究. 中华危重病急救医学, 2020,32(8):988-993.
[5] Enoch DA, Yang H, Aliyu SH, et al. The changing epidemiology of invasive fungal infections. Methods Mol Biol, 2017,1508:17-65.
[6] Pagano L, Busca A, Candoni A, et al. Risk stratification for invasive fungal infections in patients with hematological malignancies: seifem recommendations. Blood Rev. 2017,31(2):17-29.
[7] Verma N, Singh S, Taneja S, et al. Invasive fungal infections amongst patients with acute-on-chronic liver failure at high risk for fungal infections. Liver Int, 2019,39(3):503-513.
[8] 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). 实用肝脏病杂志, 2019,22(2):164-171.
[9] 中华医学会重症医学分会.重症患者侵袭性真菌感染诊断与治疗指南(2007年). 中华内科杂志, 2007,46(11):960-966.
[10] Biggins SW, Kim WR, Terrault NA, et al. Evidence-based incorporation of serum sodium concentration into meld. Gastroenterology, 2006,130(6):1652-60.
[11] Kamath PS, Wiesner RH, Malinchoc M, et al. A model to predict survival in patients with end-stage liver disease. Hepatology, 2001,33(2):464-470.
[12] Moreau R, Jalan R, Gines P, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology, 2013,144(7):1426-1437.
[13] 中华医学会肝病学分会.肝硬化肝性脑病诊疗指南. 中华内科杂志, 2018,57(10):705-718.
[14] Zhang X, Yang M, Hu J, et al. Epidemiology of invasive pulmonary aspergillosis in patients with liver failure: clinical presentation, risk factors, and outcomes. J Int Med Res, 2018,46(2):819-827.
[15] Wu T, Li J, Shao L, et al. Development of diagnostic criteria and a prognostic score for hepatitis B virus-related acute-on-chronic liver failure. Gut, 2018,67(12):2181-2191.
[16] 应高翔,杨英,吴凤天,等.慢加急性肝衰竭患者并发感染的特点及对诊断的影响. 中华临床感染病杂志, 2020,13(2):140-148.
[17] Lin S, Zhang K, Zhang J, et al. Long-term outcomes of patients with hepatitis B virus-related acute on chronic liver failure: An observational cohort study. Liver Int, 2019,39(5):854-860.
[18] 姚运海,赵卫峰,甘建和.终末期肝病模型联合动脉血乳酸对乙型肝炎病毒相关慢加急性肝衰竭预后的评价:97例患者的回顾性分析. 中华肝脏病杂志, 2019,27(4):256-260.
[19] Shen G, Sun S, Huang J, et al. Dynamic changes ofT cell receptor repertoires in patients with hepatitis B virus-related acute-on-chronic liver failure. Hepatol Int, 2020,14(1):47-56.
[20] Xie Z, Violetta L, Chen E, et al. A prognostic model for hepatitis B acute-on-chronic liver failure patients treated using a plasma exchange-centered liver support system. J Clin Apher, 2020,35(2):94-103.

多种预后评分系统预测慢加急性肝衰竭并发真菌感染患者短期预后价值分析^*

Short-term prognosis of patients with acute on chronic liver failure and invasive fungal infection by four prognostic scoring systems

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