Indocyanine green clearance test combined with MELD score in predicting the short-term prognosis of patients with acute liver failure

摘要

BACKGROUND: Acute liver failure (ALF) is an acute severe deterioration of liver function with high mortality. Early and accurate prognostic assessment of patients with ALF is critically important. Although the model for end-stage liver disease (MELD) scores and King's College Hospital (KCH) criteria are well-accepted as predictive tools, their accuracy is unsatisfactory. The indocyanine green (ICG) clearance test (ICGR15, ICG retention rate at the 15 minutes) is a sensitive indicator of liver function. In this study, we investigated the efifcacy of the ICGR15 for the short-term prognosis in patients with ALF. We compared the predictive value of ICGR15 with the MELD scores and KCH criteria. METHODS: Sixty-nine patients who had been diagnosed with ALF were recruited retrospectively. ICGR15 had been performed by ICG pulse spectrophotometry and relevant clinical and laboratory indices were analyzed within 24 hours of diagnosis. In addition, the MELD scores and KCH criteria were calculated. RESULTS: The three-month mortality of all patients was 47.83%. Age,  serum  total  bilirubin  and  creatinine  concentrations, international normalized ratio for prothrombin time, ICGR15, MELD scores and KCH criteria differed signiifcantly between surviving and deceased patients. A positive correlation was observed between ICGR15 and MELD scores (r=0.328, P=0.006). The ICGR15-MELD model, Logit(P)=0.096×ICGR15+0.174 × MELD  score-9.346,  was  constructed  by  logistic  regression analysis. The area under the receiver operating characteristic curve was 0.855. When set the cut-off point to -0.4684, the sensitivity was 87.90% and speciifcity, 72.20%. The area under the  receiver  operating  characteristic  curve  of  the  ICGR15-MELD model (0.855) was signiifcantly higher than that of the ICGR15 (0.793), MELD scores (0.776) and KCH criteria (0.659). Based on this cut-off value, the patients were divided into two groups. The mortality was 74.36% in the ifrst group (ICGR15-MELD≥-0.4686) and 13.33% in the second group (ICGR15-MELD<-0.4686), with a signiifcant difference between the two groups (χ2=25.307, P=0.000). CONCLUSION: The ICGR15-MELD model is superior to the ICGR15, MELD scores, and KCH criteria in predicting the short-term prognosis of patients with ALF.