A multicenter study on the prognosis of fulminant viral hepatitis: Early prediction for liver transplantation
A multicenter study on the prognosis of fulminant viral hepatitis: Early prediction for liver transplantation
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暴发性病毒性肝炎预后的多中心研究：肝移植的早期预测
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发表时间：
1994
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影响因子：
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通讯作者：
Y. Mizoguchi
中科院分区：
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作者：
Y. Takahashi;H. Kumada;M. Shimizu;K. Tanikawa;R. Kumashiro;M. Omata;T. Ehata;T. Tsuji;M. Ukida;M. Yasunaga;K. Okita;Shunichi Sato;T. Takeuchi;K. Tsukada;H. Obata;E. Hashimoto;Y. Ohta;K. Tada;Y. Kosaka;K. Takase;M. Yoshiba;K. Sekiyama;T. Kano;Y. Mizoguchi
为了确定暴发性病毒性肝炎早期死亡的风险，我们从128例暴发性B型肝炎患者和103例暴发性非甲非B型肝炎患者发生脑病当天的临床数据中创建了严重程度指数。在暴发性B型肝炎中，风险评分为2.75×BL+2.75×BR+2.7×AG+2.3×WB+1.67×CD+1.56×AL−0.098×PR−0.88，其中如果总胆红素高于20 mg/dl，则BL为1;如果总胆红素与直接胆红素的比值超过2.2，则BR为1;如果年龄大于40岁，则AG为1;如果白色血细胞计数小于4，则WB为1，000个细胞/mm 3或大于18，000个细胞/mm 3，如果危险疾病共存，则CD为1，如果ALT小于正常上限的100倍，则AL为1（否则均为0），PR为凝血酶原时间（正常值的百分比）。使用0分的临界值，我们发现阳性预测值，阴性预测值和预测准确性分别为0.90，0.86和0.89。敏感性和特异性分别为0.94和0.77。在暴发性非甲非B型肝炎中，风险评分为2.66×BR+2.25×BL+2.24×DI+2.05×AL ± 1.38×AG+0.00021×WB−6.33。如果总胆红素与直接胆红素的比值大于1.5，则BR为1;如果总胆红素高于15 mg/dl，则BL为1;如果脑病前疾病持续时间小于4天或大于12天，则DI为1;如果ALT水平超过正常上限的40倍，则AL为1;如果年龄超过50岁，则AG为1;否则所有变量均为0。WB是每立方毫米的WBC计数。阳性预测值、阴性预测值和预测准确率分别为0.92、0.80和0.89。敏感性和特异性分别为0.95和0.70。这些预测方程在包括52例暴发性B型肝炎患者和47例暴发性非甲非B型肝炎患者的试验样本人群中进行了前瞻性验证。对于重型B型肝炎和重型非甲、非B型肝炎患者，阳性预测值分别为0.92和0.92，阴性预测值分别为0.71和0.78，预测准确度分别为0.87和0.89。它们可用于选择肝移植的候选者和用于评估新疗法的功效。（《肝脏学》1994年;19：1065-1071）
To determine the risk of death at an early stage of fulminant viral hepatitis, we created severity indexes drawn from clinical data on the day of development of encephalopathy in 128 patients with fulminant hepatitis B and 103 with fulminant hepatitis non‐A, non‐B. In fulminant hepatitis B, the risk score was 2.75×BL+2.75×BR+2.7×AG+2.3×WB+1.67×CD+1.56×AL−0.098×PR−0.88, where BL is 1 if total bilirubin is higher than 20 mg/dl, BR is 1 if the ratio of total to direct bilirubin exceeds 2.2, AG is 1 if age is above 40 yr, WB is 1 if white blood cell count is less than 4,000 cells/mm3 or more than 18,000 cells/mm3, CD is 1 if a hazardous disease coexists and AL is 1 if ALT is less than 100 times the upper limit of normal (otherwise all are 0), and PR is prothrombin time (percentage of normal value). Using a cutoff score of 0, we found the positive predictive value, negative predictive value and predictive accuracy to be 0.90, 0.86 and 0.89, respectively. Sensitivity and specificity were 0.94 and 0.77, respectively. In fulminant non‐A, non‐B hepatitis, the risk score was 2.66×BR+2.25×BL+2.24×DI+2.05×AL ± 1.38×AG+0.00021×WB−6.33. BR is 1 if the ratio of total to direct bilirubin is more than 1.5, BL is 1 if total bilirubin is higher than 15 mg/dl, DI is 1 if the duration of illness before encephalopathy is less than 4 days or more than 12 days, AL is 1 if the ALT level exceeds 40 times the upper limit of normal and AG is 1 if age exceeds 50; otherwise all variables are 0. WB is WBC count per cubic millimeter. Positive predictive value, negative predictive value and predictive accuracy were 0.92, 0.80 and 0.89, respectively. Sensitivity and specificity were 0.95 and 0.70, respectively. These prediction equations were validated prospectively on a population of testing samples comprising 52 patients with fulminant hepatitis B and 47 with fulminant non‐A, non‐B hepatitis. Positive predictive values were 0.92 and 0.92, negative predictive values were 0.71 and 0.78 and predictive accuracies were 0.87 and 0.89 for patients with fulminant hepatitis B and fulminant non‐A, non‐B hepatitis, respectively. They may be used for selecting candidates for liver transplantation and for evaluating efficacy of a new therapy. (HEPATOLOGY 1994;19:1065–1071.)