Abstract:Nine prognostic models for end-stage liver diseases were used to assess the prognosis of the patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) and the influencing factors of mortality were analyzed. A total of 91 HBV-ACLF patients who received treatment in Huashan Hospital, Fudan University, from July 2014 to July 2018 were selected. The predictive value of nine prognostic models was assessed by the areas under receiver operating characteristic curves (AUROCs), and the influencing factors of mortality were analyzed by logistic regression model. Among 91 patients with HBV-ACLF, 46 died within 90 d. COSSH-ACLF score model presented the best predictive value (AUROC: 0.946 for 28-day mortality and 0.920 for 90-day mortality). AUROCs of the patients graded by the number of organ failure were: grades 0-1: 0.900 for 28-day mortality and 0.846 for 90-day mortality; grades 2-3: 0.957 for 28-day mortality and 0.917 for 90-day mortality. The cutoff of COSSH-ACLF score was 6.245. The survival rate of the patients with COSSH-ACLF score >6.245 was significantly lower than those ≤6.245 (10.7% vs. 81.8%, P<0.000 1). The independent predictors of mortality were age, total bilirubin, coagulation failure, hepatic encephalopathy and platelet count. The platelet count in the survival group was significantly higher than that in the death group (P<0.002 2). The results suggest that COSSH-ACLF score model is clinically practical for the prognosis of HBV-ACLF patients, and platelet count is associated with the severity and prognosis of HBV-ACLF patients.
张雪云,应悦,刘小琴,余雪平,张继明,黄玉仙. 基于终末期肝病评分模型对91例乙型肝炎病毒相关性慢加急肝衰竭患者预后的评估及死亡危险因素分析[J]. 微生物与感染, 2019, 14(1): 8-15.
ZHANG Xueyun, YING Yue, LIU Xiaoqin, YU Xueping, ZHANG Jiming, HUANG Yuxian. Assessment of various prognostic model and analysis of predictors for 91 patients with hepatitis B virus-related acute-on-chronic liver failure. JOURNAL OF MICROBES AND INFECTIONS, 2019, 14(1): 8-15.