基于急性至慢性肝衰竭的动态评估预测了肝移植后患者的存活率:一项队列研究
Wei Zhang1,2, Pingbo Jin1,2, Junfang Liu1,2
1Department of Hepatobiliary and Pancreatic Surgery.
International journal of surgery (London, England)
|July 27, 2023
概括
使用慢性肝衰竭-器官衰竭 (CLIF-OF) 评分的临床过程的动态评估显著预测了肝移植后的死亡率,超过了末期肝病模型 (MELD) 评分. 病情恶化表明预后更差,这凸显了动态评估对风险分层的重要性.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 移植医学 移植医学
- 关键护理医学 关键护理医学
背景情况:
- 对重症患者的动态评估对于预测结果至关重要.
- 目前的末期肝病模型 (MELD) 和急性至慢性肝衰竭 (ACLF) 评分通常依赖于时间点评估.
- 本研究研究了动态临床过程变化对肝移植后 (LT) 存活率的影响.
研究的目的:
- 评估动态临床过程变化对肝移植后存活率的影响.
- 为了比较基于动态ACLF得分 (ΔCLIF-OF) 与动态MELD得分 (ΔMELD) 的预测能力.
- 确定影响LT后死亡率的关键风险因素.
主要方法:
- 包括637名患有末期肝病的成年人,比较基于MELD和ACLF的动态评估得分.
- 确定了158名患有ACLF-3的患者的特定队列.
- 利用 ΔMELD 和 ΔCLIF-OF 来表示动态变化,通过 AUC 评估歧视,并使用考克斯回归来识别风险因素.
主要成果:
- 与ΔMELD相比,动态CLIF-OF (ΔCLIF-OF) 显示出更高的预测准确度 (AUC 0.752-0.767) 与ΔMELD相比.
- 临床疗程恶化的患者 (ΔCLIF-OF ≥2) 的1年死亡率明显更高 (HR总体为12.57,ACLF-3队列为7.00).
- 肝外器官衰竭,CLIF-OF在LT, ΔCLIF-OF和冷血缺血时间是死亡的独立风险因素.
结论:
- 动态CLIF-OF比ΔMELD更强大地预测LT后死亡率.
- 肝外器官衰竭是关键的危险因素,特别是在ACLF-3患者.
- 动态评估对于肝移植中准确的风险分层和接受者选择至关重要.
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