Combining serum cystatin C with total bilirubin improves short-term mortality prediction in patients with HBV-related acute-on-chronic liver failure.
Combining serum cystatin C with total bilirubin improves short-term mortality prediction in patients with HBV-related acute-on-chronic liver failure.
复制标题
将血清胱抑素 C 与总胆红素结合可改善 HBV 相关慢性急性肝衰竭患者的短期死亡率预测
DOI：
10.1371/journal.pone.0116968
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Xin S
中科院分区：
文献类型：
--
作者：
Wan Z;Wu Y;Yi J;You S;Liu H;Sun Z;Zhu B;Zang H;Li C;Liu F;Li D;Mao Y;Xin S
背景与目的乙型肝炎病毒相关性急性慢性肝衰竭是中国病死率较高的一种严重肝病。早期预测患者预后，可预防并发症，提高生存率。本研究旨在开发一种新的预后指标来估计与HBV-ACLF相关的生存时间。方法对连续入选的乙肝急性加重期肝功能衰竭患者进行前瞻性观察研究。采用颗粒增强免疫比浊法测定血清Cystatin C浓度。所有患者均获得至少3个月的随访。采用COX回归分析确定哪些因素对死亡率有预测作用。受试者工作特征曲线下面积(AUC)被用来评估这些变量对早期预测死亡率的有效性。结果自2012年1月至2013年1月共入选72例慢性乙型肝炎急性加重期患者。随访3个月死亡30例(41.7%)。COX多因素回归分析显示，血清胱抑素C(CysC)和总胆红素(TBil)是影响预后的独立因素(P<0.01)。我们的结果进一步表明，结合血清CysC和总胆红素的新的预后指数(PI)是预测HBVACLF患者病死率的良好指标。具体地说，PI比CTP、MELD或MELD-Na评分具有更高的准确性，可以早期预测血清肌酐(Cr)正常的乙肝-ACLF患者的短期生存。低危组生存率为94.3%，明显高于高危组(PI≥3.91)(17.4%，P<；0.001)。结论结合血清CysC和总胆红素水平，建立了一种新的预后指标，可早期预测乙肝急性加重期肝功能衰竭患者的近期死亡率。
Background & Aims HBV-related acute-on-chronic liver failure (HBV-ACLF) is a severe liver disease which results in a high mortality in China. To early predict the prognosis of the patients may prevent the complications and improve the survival. This study was aimed to develop a new prognostic index to estimate the survival related to HBV-ACLF. Methods Consecutive patients with HBV-ACLF were included in a prospective observational study. Serum Cystatin C concentrations were measured by using the particle-enhanced immunonephelometry assay. All of the patients were followed for at least 3 months. Cox regression analysis was carried out to identify which factors were predictive of mortality. The area under the receiver operating characteristic curve (AUC) was used to evaluate the efficacy of the variates for early predicting mortality. Results Seventy-two patients with HBV-ACLF were recruited between January 2012 and January 2013. Thirty patients died (41.7%) during 3-months followed up. Cox multivariate regression analysis identified serum cystatin C (CysC) and total bilirubin (TBil) were independent factors significantly (P < 0.01) associated with survival. Our results further showed that new prognostic index (PI) combining serum CysC with TBil was a good indicator for predicting the mortality of patients with HBV-ACLF. Specifically, the PI had a higher accuracy than the CTP, MELD, or MELD-Na scoring for early prediction short-term survival of HBV-ACLF patients with normal levels of serum creatinine (Cr). The survival rate in low risk group (PI < 3.91) was 94.3%, which was markedly higher than those in the high-risk group (PI ≥ 3.91) (17.4%, P < 0.001). Conclusion We developed a new prognostic index combining serum CysC with TBil which early predicted the short-term mortality of HBV-ACLF patients.
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