肝脏特异多器官功能衰竭评分预测乙型肝炎肝硬化急性失代偿患者短期死亡的对比研究

摘要

Background:Recently the European consortium proposed a diagnostic criteria for acute-on-chronic liver failure in patients with acute decompensation( AD)of non-HBV-related cirrhosis,i. e. ,Chronic Liver Failure-Consortium Organ Failure score( CLIF-C OFs). Aims:To assess the performance of CLIF-C OFs in predicting short-term mortality for HBV-related cirrhosis patients with AD. Methods:A total of 890 hospitalized HBV-related chronic liver disease patients with AD from Jan. 2005 to Dec. 2010 in Shanghai Ren Ji Hospital were enrolled. Of them,264 patients received liver transplantation within 90 days and 95. 1% were pathologically diagnosed as cirrhosis. Kaplan-Meier survival curve was used to analyze the 28-day and 90-day cumulative survival rates in patients stratified by amount of organ failure. Logistic regression model was applied to analyze the factors associated with 28-day mortality. ROC curve was used to compare the performance of CLIF-C OFs in predicting short-term mortality with Model of End-stage Liver Disease( MELDs),MELD-Sodium score( MELD-Nas),and Child-Turcotte-Pugh( CTPs). Results:Cumulative survival rates of 28-day and 90-day for HBV-related cirrhosis patients with AD were closely related with the amount of organ failure(P<0. 001). Serum total bilirubin,serum creatinine,hepatic encephalopathy and white blood cell were independent risk factors for 28-day mortality. Area under ROC curve of CLIF-C OFs for predicting 28-day mortality was 0. 813 ± 0. 021 and the optimal cut-off value was 8,with the sensitivity,specificity,positive predictive value,and positive likelihood ratio being 84. 3%,64. 9%,31. 9%and 2. 4,respectively. The predictive performance of CLIF-C OFs was similar to MELDs and MELD-Nas. Conclusions:CLIF-C OFs is a good predictor of short-term mortality for HBV-related cirrhosis patients with AD,and is worthy of being used in clinical practice.%近年，欧洲提出了非乙型肝炎肝硬化伴急性失代偿（ AD）基础上慢加急肝功能衰竭的诊断标准，如慢性肝功能衰竭协会-器官功能衰竭评分（CLIF-C OFs）。目的：评估CLIF-C OFs 对乙型肝炎肝硬化伴AD 患者短期死亡的预测效能。方法：2005年1月-2010年12月上海仁济医院住院乙型肝炎相关慢性肝病伴AD 患者890例纳入研究，264例90 d 内接受肝移植术者中95.1%病理诊断为肝硬化。以Kaplan-Meier 生存曲线按器官衰竭数量分组分析28 d 和90 d 累积生存率，以Logistic 回归模型分析28 d 死亡的影响因素，以ROC 曲线比较CLIF-C OFs 与终末期肝病模型评分（MELDs）、终末期肝病模型-钠评分（MELD-Nas）、肝功能分级评分（CTPs）对短期死亡的预测效能。结果：乙型肝炎肝硬化伴AD 患者28 d 和90 d 累积生存率与器官衰竭数量密切相关（P <0.001）。血清总胆红素、血清肌酐、肝性脑病和白细胞是患者28 d 死亡的独立危险因素。CLIF-C OFs 预测28 d 死亡的ROC 曲线下面积为0.813±0.021，最佳临界值为8，相应敏感性、特异性、阳性预测值、阳性似然比分别为84.3%、64.9%、31.9%和2.4，预测效能与MELDs 和MELD-Nas 相似。结论：CLIF-C OFs 能较好地预测乙型肝炎肝硬化伴AD 患者的短期死亡，可应用于临床实践。