Predictive formula of coma onset and prothrombin time to distinguish patients who recover from acute liver injury
Predictive formula of coma onset and prothrombin time to distinguish patients who recover from acute liver injury
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DOI：
10.1111/jgh.13819
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发表时间：
2018-01-01
影响因子：
4.1
通讯作者：
Takikawa, Yasuhiro
中科院分区：
文献类型：
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作者：
Kakisaka, Keisuke;Suzuki, Yuji;Takikawa, Yasuhiro
背景与目的急性肝衰竭（acute liver failure，ALF）是指与凝血功能障碍相关的急性肝损伤（acute liver injury，ALI）.尚未建立ALI的随访策略和有进展为ALF风险的ALI患者的特征。为了建立从ALI进展到ALF的预测标志物，本研究将登记当天的临床特征和实验室数据与来自ALI.MethodsThis区域转诊系统的患者数据进行了比较。我们评估了109例ALI患者，其中27人满意的ALF标准在观察期间，另有82例患者恢复无进展ALF.Results4例患者死亡，均在ALF组。ALF患者登记时的年龄、自身免疫性肝炎发生率、终末期肝病评分模型、总胆红素和凝血酶原时间（PT）-国际比值以及日本肝性脑病预测模型（JHEPM）概率等变量均显著高于ALI患者。在多变量分析中，PT和JHEPM被确定为进展为ALF的风险因素。终末期肝病评分、JHEPM概率、PT和PT-国际比值模型的截止值分别为13%、4.9%、65%和1.32%，具有较高的阴性预测值。此外，在JHBPM被低估的患者中，没有人因ALF而死亡。结论JHBPM概率是一个预测参数，可用于决定ALI患者的后续治疗策略。
Background and AimAcute liver failure (ALF) is defined as acute liver injury (ALI) associated with coagulopathy. A follow-up strategy for ALI and characterization of ALI patients with a risk of progressing to ALF have never been established. To establish predictive markers for progression from ALI to ALF, this study compared the clinical characteristics and laboratory data on the day of registration to data from a regional referral system of patients with ALI.MethodsThis prospective, observational study enrolled 365 consecutive patients with ALI/ALF between 2007 and 2016. We evaluated 109 ALI patients, 27 of whom satisfied the ALF criteria during observation and another 82 patients who recovered without progression to ALF.ResultsFour patients died; all were in the ALF group. The variables of age, incidence of autoimmune hepatitis, model of end-stage liver disease score, values for total bilirubin and prothrombin time (PT)-international ratio, and Japan Hepatic Encephalopathy Prediction Model (JHEPM) probability at registration were significantly higher in ALF patients than in ALI patients. In multivariate analysis, PT and JHEPM were identified as risk factors for progression to ALF. The cut-off values of 13%, 4.9%, 65%, and 1.32% for the model of end-stage liver disease score, JHEPM probability, PT, and PT-international ratio values, respectively, had high negative predictive values. Furthermore, among patients whose JHEPM was underestimated, none died due to ALF.ConclusionThe JHEPM probability is a predictive parameter that can be used to decide a follow-up treatment strategy for ALI patients.