Analysis of clinical short-term prognostic factors in patients with hepatitis B-related acute-on-chronic liver failure

Abstract

Objective To explore the relationship between the model for end-stage liver disease (MELD) score, total bilirubin, albumin, international normalized ratio and prothrombin activity and the prognosis in patients with hepatitis B-related acute-on-chronic liver failure (ACLF).

Methods A total of 124 patients with hepatitis B-related ACLF who were admitted from January 2018 to December 2020 were collected from the Department of Infection, the First Affiliated Hospital of Bengbu Medical University. The relevant indexes of liver function and coagulation function were collected, and whether the patients were treated with artificial liver or not, and the MELD score was also evaluated. On the basis of the clinical outcome after 90-day admission, the patients were divided into the survival group and death group. Data of MELD score, total bilirubin, albumin, international normalized ratio and prothrombin activity were compared between the two groups. Logistic regression analysis was used to study the relationship between various indexes and the prognosis of HBV-ACLF patients.

Results The MELD score, the international normalized ratio and the total and the ages bilirubin in the survival group were (22.66±4.69) scores, 1.72±0.42 and (281.09±94.21) µmol/L and (40.54±7.39) ages, respectively, which were significantly lower than those in the death group [(31.38±5.39) scores, 2.64±0.61 and (360.54±130.97) µmol/L and (45.73±12.72) ages], all of the differences were statistically significant (all P<0.05). The albumin and prothrombin activity in the survival group were (31.21±3.83) g/L and (35.95±11.82) %, respectively, which were significantly higher than those in the death group [(28.43±4.46) g/L and (29.54±12.10) %)], all of the differences were statistically significant (all P<0.05). Logistic regression analysis showed that the higher MELDscore, the higher level of TBIL, the higher level of INRand the elder age were considered as independent risk factors of ACLF patients, and albumin and prothrombin activity were considered as protective factors of ACLF patients.

Conclusion The MELD score, total bilirubin, albumin, international normalized ratio and protlirombin activity can be used as prognostic predictors in sepsis patients.

Abstract

摘要：目的 探讨终末期肝病模型(MELD)评分、总胆红素、白蛋白、国际标准化比值、凝血酶原活动度与乙肝相 关的慢加急性肝衰竭(ACLF)患者短期预后的关系。 方法 收集2018年1月一2020年12月蚌埠医学院第一附 属医院感染性疾病科住院的乙肝相关ACLF患者124例, 收集患者肝功能、凝血功能等相关指标数据, 注意患者 是否行人工肝治疗, 并进行MELD评分。根据患者人院后90 d是否存活, 分为存活组(68 例)和死亡组(56例)。分别比较2组患者的MELD评分、总胆红素、白蛋白、国际标准化比值、凝血酶原活动度、年龄, 使用logistic回归 分析研究各项指标与HBV-ACLF患者预后的关系。 结果 存活组患者的MELD评分、国际标准化比值、总胆红 素、年龄分别为(22.66±4.69)分、1.72±0.42、(281.09±94.21) µmol/L、(40.54±7.39)岁, 均显著低于死亡组 [(31.38±5.39)分、2.64±0.61、(360.54±130.97) µmol/L、(45.73±12.72)岁], 差异均有统计学意义(均 P<0.05);存活组患者白蛋白、凝血酶原活动度分别为(31.21±3.83) g/L、(35.95±11.82) %, 均显著高于死亡组患 者[(28.43±4.46) g/L、(29.54±12.10) %], 差异均有统计学意义(均 P<0.05)。Logistic 回归分析显示, MELD 评分高、高水平TBil、高水平INR、年龄大是ACLF患者的独立危险因素, 高水平Alb、高水平PTA是ACLF患者的 保护因素。 结论 MELD评分、总胆红素、白蛋白、国际标准化比值、凝血酶原活动度均可作为预测ACLF患者短 期预后的相关指标。