Liver volume based prediction model for patients with hepatitis B virus-related acute-on-chronic liver failure.
Liver volume based prediction model for patients with hepatitis B virus-related acute-on-chronic liver failure.
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DOI：
10.1002/jhbp.1112
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发表时间：
2022-12
影响因子：
3
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中科院分区：
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B型肝炎病毒相关的慢性加急性肝衰竭（HBV‐ACLF）是一种危及生命的疾病，短期死亡率较高。早期和准确的预后是重要的临床决策，其中肝脏体积（LV）提供了重要的信息。然而，LV尚未在HBV‐ACLF的当前预后模型中考虑。323例患者入组衍生队列，163例入组验证队列。主要终点是入院后28天内死亡。采用基于健康人群的公式计算估计肝脏体积（ELV）。Logistic回归用于建立预测模型。用受试者工作特征（ROC）曲线评价模型的准确性。在非存活者中，LV与ELV的比值（LV/ELV%）显著较低，LV/ELV% ≤82%表明预后不良。 L V/ E LV%、A ge、凝血酶原时间（PT）、肝性脑病（HE）分级、ln转换的总胆红素（lnT B il）和对数转换的HBV DNA（Log 10 HBV DNA）被确定为开发基于LV的模型LEAP-HBV的独立预测因素。LEAP-HBV的平均ROC下面积（AUC）为0.906（95% CI，0.904 - 0.908），高于其他非基于LV的模型。肝脏体积是一个独立的预测因子，LEAP‐HBV是一个基于LV的预测模型，用于HBV‐ACLF的短期死亡率。本研究已在ClinicalTrails（NCT 03977857）上注册。
Hepatitis B virus‐related acute‐on‐chronic liver failure (HBV‐ACLF) is a life‐threatening disease with high short‐term mortality. Early and accurate prognosis is significant for clinical decisions, in which liver volume (LV) imparts important information. However, LV has not been considered in current prognostic models for HBV‐ACLF. Three hundred and twenty‐three patients were recruited to the deriving cohort, while 163 were enrolled to validation cohort. The primary end‐point was death within 28 days since admission. Estimated liver volume (ELV) was calculated by the formula based on healthy population. Logistic regression was used to develop a prediction model. Accuracy of models were evaluated by receiver operating characteristic (ROC) curves. The ratio of LV to ELV (LV/ELV%) was significantly lower in non‐survivors, and LV/ELV% ≤82% indicated poor prognosis. L V/ E LV%, A ge, prothrombin time ( P T), the grade of hepatic encephalopathy ( H E), ln‐transformed total bilirubin (lnT B il), and log‐transformed HBV DNA (Log10 HB V DNA) were identified as independent predictors to develop an LV‐based model, LEAP‐HBV. The mean area under the ROC (AUC) of LEAP‐HBV was 0.906 (95% CI, 0.904‐0.908), higher than other non‐LV‐based models. Liver volume was an independent predictor, and LEAP‐HBV, a prediction model based on LV, was developed for the short‐term mortality in HBV‐ACLF. This study was registered on ClinicalTrails (NCT03977857).
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