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在患有急性-慢性肝衰竭的患者中死亡率的预后因素

Huijie Jiang¹, Zhihao Zhao, Shiyu Cui

¹Department of Liver Diseases, Public Health Clinical Center Affiliated to Shandong University, Jinan, China.

European journal of gastroenterology & hepatology

|April 10, 2025

概括

在急性至慢性肝衰竭 (ACLF) 中确定90天死亡率的预后因素至关重要. 纳入年龄,肝脑病 (HE),上胃肠道出血 (UGB),肝硬化,总胆红素 (TBIL),血小板与中性粒细胞的比率 (PNR) 和国际正常化比率 (INR) 的AHUCTPI模型,准确地预测了结果.

科学领域:

肝病学肝病学是一种肝病学.
内部医学内部医学
关键护理医学关键护理医学

背景情况:

急性至慢性肝衰竭 (ACLF) 是一种严重的临床综合征,短期死亡率高.
早期识别重病ACLF患者对于及时干预和改善结果至关重要.

研究的目的:

确定ACLF患者90天死亡率的显著预后因素.
开发和验证一种新的预后模型,用于预测ACLF的90天死亡率.
评估动态实验室标记物变化对ACLF患者存活率的影响.

主要方法:

对288名ACLF患者的回顾性分析,按90天生存率分类.
多变量阶段逻辑回归来确定独立的预后因素.
构建和内部验证AHUCTPI预后模型.
将AHUCTPI模型的性能与MELD得分进行比较.

主要成果:

90天死亡率的独立预测因素包括年龄≥45岁,肝脑病 (HE),上胃肠道出血 (UGB),肝硬化,总胆红素 (TBIL) 升高,血小板与中性粒细胞的比率降低 (PNR) 和国际正常化比率升高 (INR).
与MELD得分 (AUC=0.739) 相比,新的AHUCTPI模型显示出更高的预测准确性 (AUC=0.914).
AHUCTPI模型显示出优异的校准,接近理想的预测性能.

结论:

年龄,HE,UGB,肝硬化,基线TBIL,PNR和INR是ACLF90天死亡率的重要预测因素.
AHUCTPI模型为预测ACLF患者死亡率提供了出色的歧视和校准.
实验室趋势的动态监测可以提高预后准确性,并指导ACLF管理中的临床决策.

关键词:

急性-慢性肝功能衰竭肝功能衰竭动态趋势动态趋势影响因素是影响因素.预测模型预测模型预后预后预后

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