Weighted thyroid-stimulating hormone disturbance in prognosis of hepatitis B virus-related acute-on-chronic liver failure
Weighted thyroid-stimulating hormone disturbance in prognosis of hepatitis B virus-related acute-on-chronic liver failure
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DOI：
10.1111/hepr.13970
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发表时间：
2023-10-17
影响因子：
4.2
通讯作者：
Wu，Daxian
中科院分区：
文献类型：
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作者：
Tu，Yasi;Ji，Feiyang;Wu，Daxian
AimTo权衡甲状腺激素在灾难性急慢性肝衰竭（ACLF）中的预后价值MethodsA回顾性队列（n= 635）和两个前瞻性队列（n= 353和198）入选本研究。一个新的开发的预后评分的性能进行了评估，从可靠性，歧视，和临床净benefit.ResultsThyroid‐stimulating hormone（TSH）的方面被确定为最有潜力的预后预测因子之间的甲状腺激素的B病毒相关的ACLF。使用回顾性队列（n= 635），在CLIF-OFs中使用加权TSH和其他评分器官开发新评分（改良慢性肝功能衰竭-器官衰竭评分[mCLIF-OFs]）。在mCLIF-OFs的十分位数中，预测的风险和观察到的死亡概率相当（Hosmer-Lemeshow χ2= 4.28，p = 0.83; Brier量表= 11.9）。mCLIF-OFs的30天死亡率C-指数（0.885 [0.883-0.887]）显著高于CLIF-OFs、慢性肝衰竭-序贯器官衰竭评估评分（CLIF-SOFA）、CLIF-C ACLF、终末期肝病模型（MELD）和Child-Pugh（allp< 0.001）。与上述五个评分相比，mCLIF-OFs的预测错误率的绝对改善为19.0%至61.1%。经过概率密度函数分析，mCLIF-OFs在上述预后评分中显示出最少的重叠系数（27.9%）。此外，在广泛的死亡风险阈值范围内，mCLIF-OFs显示出比上述5种预后评分更大的净获益。类似的结果在两个前瞻性ACLF队列与HBV和non-HBV病因进行了验证。ConclusionWeighted TSH预示着ACLF患者的结果，这可以被视为下丘脑-垂体-甲状腺轴的“受损器官”。新型mCLIF-OFs是一种可靠的预后评分，与CLIF-OFs、CLIF-SOFA、CLIF-C ACLF、MELD和Child-Pugh相比，具有更好的区分力和临床净获益。
AimTo weight the prognostic value of thyroid hormones in catastrophic acute‐on‐chronic liver failure (ACLF).MethodsA retrospective cohort (n= 635) and two prospective cohorts (n= 353, and 198) were enrolled in this study. The performance of a novel developed prognostic score was assessed from aspects of reliability, discrimination, and clinical net benefit.ResultsThyroid‐stimulating hormone (TSH) was identified to have the most potential as a prognostic predictor for hepatitis B virus‐related ACLF among thyroid hormones. The novel score (modified chronic liver failure–organ failure score [mCLIF‐OFs]) was developed with weighted TSH and other scored organs in the CLIF‐OFs using the retrospective cohort (n= 635). The predicted risk and observed probabilities of death were comparable across the deciles of mCLIF‐OFs (Hosmer–Lemeshow χ2= 4.28,p= 0.83; Brier scaled = 11.9). The C‐index of mCLIF‐OFs (0.885 [0.883–0.887]) for 30‐day mortality was significantly higher than that of the CLIF‐OFs, chronic liver failure–sequential organ failure assessment score (CLIF‐SOFAs), CLIF‐C ACLFs, Model of End‐stage Liver Disease (MELD), and Child–Pugh (allp< 0.001). The absolute improvements of prediction error rates of the mCLIF‐OFs compared to the above five scores were from 19.0% to 61.1%. After the analysis of probability density function, the mCLIF‐OFs showed the least overlapping coefficients (27.9%) among the above prognostic scores. Additionally, the mCLIF‐OFs showed greater net benefit than the above five prognostic scores over a wide range of risk threshold of death. Similar results were validated in two prospective ACLF cohorts with HBV and non‐HBV etiologies.ConclusionWeighted TSH portended the outcome of ACLF patients, which could be treated as a “damaged organ” of the hypothalamic–pituitary–thyroid axis. The novel mCLIF‐OFs is a reliable prognostic score with better discrimination power and clinical net benefit than CLIF‐OFs, CLIF‐SOFAs, CLIF‐C ACLFs, MELD, and Child–Pugh.