Prediction of the prognosis of patients with acute-on-chronic hepatitis B liver failure using the model for end-stage liver disease scoring system and a novel logistic regression model
Prediction of the prognosis of patients with acute-on-chronic hepatitis B liver failure using the model for end-stage liver disease scoring system and a novel logistic regression model
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DOI：
10.1111/j.1365-2893.2008.01046.x
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发表时间：
2009-07-01
影响因子：
2.5
通讯作者：
Sheng, J. -F.
中科院分区：
文献类型：
--
作者：
Sun, Q. -F.;Ding, J. -G.;Sheng, J. -F.
本研究旨在探讨终末期肝病模型（MELD）评分系统对慢性加急性B型肝炎肝衰竭（ACLF-HBV）患者的预测价值，并建立一种新的预测ACLF-HBV预后的模型。在2002年7月1日至2004年12月31日期间，共回顾性招募了204例成人ACLF-HBV患者。根据广泛接受的公式计算MELD评分。计算3个月死亡率。MELD模型的有效性通过一致性（c）统计量确定。对临床资料和生化指标进行多因素Logistic回归分析，建立预后预测模型。绘制MELD评分系统和新回归模型的受试者工作特征曲线，并通过z检验比较曲线下面积（AUC）。3个月死亡率为57.8%。死亡患者的平均MELD评分显著高于存活超过3个月的患者（28.7 vs 22.4，P = 0.003）。MELD评分系统预测3个月死亡率的一致性（c）统计量（相当于AUC）为0.709（SE = 0.036，P < 0.001，95%置信区间0.638-0.780）。多因素Logistic回归分析显示影响预后的独立因素为肝肾综合征（P < 0.001）、肝硬化（P = 0.009）、HBeAg（P = 0.013）、白蛋白（P = 0.028）和凝血酶原活动度（P = 0.011）。Logistic回归分析建立的回归模型的预后价值（c = 0.891）高于MELD评分系统（z = 4.333，P < 0.001）。MELD评分系统是一个有前途的和有用的预测3个月的死亡率ACLF-HBV患者。肝肾综合征、肝硬化、HBeAg、白蛋白、凝血酶原活动度是影响3个月病死率的独立因素。新建立的logistic回归模型在预测ACLF-HBV患者3个月死亡率方面似乎优于MELD评分系统上级。
The objective of this study was to determine the predictive value of the model for end-stage liver disease (MELD) scoring system in patients with acute-on-chronic hepatitis B liver failure (ACLF-HBV), and to establish a new model for predicting the prognosis of ACLF-HBV. A total of 204 adult patients with ACLF-HBV were retrospectively recruited between July 1, 2002 and December 31, 2004. The MELD scores were calculated according to the widely accepted formula. The 3-month mortality was calculated. The validity of the MELD model was determined by means of the concordance (c) statistic. Clinical data and biochemical values were included in the multivariate logistic regression analysis based on which the regression model for predicting prognosis was established. The receiver-operating characteristic curves were drawn for the MELD scoring system and the new regression model and the areas under the curves (AUC) were compared by the z-test. The 3-month mortality rate was 57.8%. The mean MELD score for the patients who died was significantly greater than those who survived beyond 3 months (28.7 vs 22.4, P = 0.003). The concordance (c) statistic (equivalent to the AUC) for the MELD scoring system predicting 3-month mortality was 0.709 (SE = 0.036, P < 0.001, 95% confidence interval 0.638-0.780). The independent factors predicting prognosis were hepatorenal syndrome (P < 0.001), liver cirrhosis (P = 0.009), HBeAg (P = 0.013), albumin (P = 0.028) and prothrombin activity (P = 0.011) as identified in multivariate logistic regression analysis. The regression model that was constructed by the logistic regression analysis produced a greater prognostic value (c = 0.891) than the MELD scoring system (z = 4.333, P < 0.001). The MELD scoring system is a promising and useful predictor for 3-month mortality of ACLF-HBV patients. Hepatorenal syndrome, liver cirrhosis, HBeAg, albumin and prothrombin activity are independent factors affecting the 3-month mortality. The newly established logistic regression model appears to be superior to the MELD scoring system in predicting 3-month mortality in patients with ACLF-HBV.