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Title: [Clinical significance of CTP combined with ABIC score in predicting the short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure].
Author: Cao D, Li DJ, Wang Y, Zhang YH, Chen LY, Wang LC.
Journal: Zhonghua Gan Zang Bing Za Zhi; 2019 Feb 20; 27(2):118-122. PubMed ID: 30818916.
Abstract:
Objective: To investigate the risk factors affecting the short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF), and establish a new scoring model to predict the short-term prognosis of patients. Methods: This study enrolled 222 patients with HBV-ACLF. According to their clinical outcomes during hospitalization and 90 days after discharge, they were divided into survival and death group. Clinical data were collected to calculate the Child-Turcotte-Pugh (CTP), model for end-stage liver disease (MELD), albumin-bilirubin (ALBI), and age-bilirubin-international normalized ratio-creatinine (ABIC) scores for prognosis. Multivariate logistic regression analysis was used to analyze the independent risk factors affecting 90-day mortality in HBV-ACLF patients. Cox regression model was used to establish a new prediction model. Area under the receiver operating characteristic curve was used to calculate short-term prognostic value of the models. K-M survival curve was used to predict the prognosis of patients. Results: CTP and ABIC scores were independent risk factors for 90-day mortality in HBV-ACLF patients, and the risk of death from liver failure had increased with increase of score. Cox regression model established a new predictive model CTP-ABIC = 0.551 × CTP + 0.297 × ABIC. Area under the receiver operating characteristic curve of all three scoring models (CTP, ABIC and CTP-ABIC) were 0.878, 0.829, 0.927, respectively. CTP-ABIC score was superior to the CTP and ABIC score (P value < 0.001). Patients with CTP-ABIC score ≥9.08 had higher mortality rate than patients with CTP-ABIC score < 9.08, and the difference was statistically significant (P < 0.001). Conclusion: All three scoring systems can predict short-term prognosis in patients with HBV-ACLF, but the accuracy of CTP-ABIC is superior. 目的： 探讨影响乙型肝炎相关性慢加急性肝衰竭（HBV-ACLF）短期预后的危险因素，并建立新的评分模型预测患者短期预后。 方法： 研究共纳入222例HBV-ACLF患者，根据其住院期间及出院后90 d的临床转归分为生存组和死亡组，分别收集临床资料进行肝功能评分（CTP）、终末期肝病模型（MELD）、白蛋白-胆红素（ALBI）、年龄-胆红素-白蛋白-肌酐（ABIC）评分，多因素logical回归法分析影响HBV-ACLF患者90 d病死率的独立危险因素后，通过Cox回归模型建立新的预测模型，应用受试者工作特征曲线评价模型对短期预后的价值，并用K-M生存曲线分析预测患者预后。 结果： CTP、ABIC评分是HBV-ACLF患者90 d病死率的独立危险因素，随着得分的增加，肝衰竭发生死亡的风险就会增加。Cox回归模型建立新的预测模型CTP-ABIC = 0.551×CTP + 0.297×ABIC，CTP、ABIC、CTP-ABIC三种评分模型的曲线下面积分别为0.878、0.829、0.927，CTP-ABIC评分优于CTP、ABIC评分，P值均< 0.001，差异均有统计学意义。CTP-ABIC评分≥9.08患者较CTP-ABIC评分< 9.08患者病死率增高，差异具有统计学意义（P < 0.001）。 结论： 三种评分系统均能较好地预测HBV-ACLF患者的短期预后，CTP-ABIC评分模型准确性更高。.

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