Prognosis prediction performs better in patients with non-cirrhosis hepatitis B virus-related acute-on-chronic liver failure than those with cirrhosis.
Prognosis prediction performs better in patients with non-cirrhosis hepatitis B virus-related acute-on-chronic liver failure than those with cirrhosis.
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非肝硬化乙型肝炎病毒相关慢性肝衰竭患者的预后预测优于肝硬化患者
DOI：
10.3389/fmicb.2022.1013439
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发表时间：
2022
影响因子：
5.2
通讯作者：
Shi, Yu
中科院分区：
文献类型：
--
作者：
Yu, Xia;Li, Hai;Tan, Wenting;Wang, Xianbo;Zheng, Xin;Huang, Yan;Li, Beiling;Meng, Zhongji;Gao, Yanhang;Qian, Zhiping;Liu, Feng;Lu, Xiaobo;Shang, Jia;Yan, Huadong;Zheng, Yubao;Zhang, Weituo;Yin, Shan;Gu, Wenyi;Deng, Guohong;Xiang, Xiaomei;Zhou, Yi;Hou, Yixin;Zhang, Qun;Xiong, Shue;Liu, Jing;Chen, Ruochan;Long, Liyuan;Chen, Jinjun;Jiang, Xiuhua;Luo, Sen;Chen, Yuanyuan;Jiang, Chang;Zhao, Jinming;Ji, Liujuan;Mei, Xue;Li, Jing;Li, Tao;Zheng, Rongjiong;Zhou, Xinyi;Ren, Haotang;Sheng, Jifang;Shi, Yu
乙型肝炎病毒相关慢加急性肝衰竭（HBV - ACLF）患者群体的异质性阻碍了对其预后的准确预测。本研究旨在评估潜在肝硬化对临床预测模型（CPMs）效能的影响。
利用来自两个多中心、前瞻性HBV - ACLF患者队列的数据，分别评估了CPMs对有肝硬化和无肝硬化患者28天及90天预后的判别能力、校准度和临床获益情况。
依据中国重型乙型肝炎研究协作组（COSSH）标准，共确定了919例HBV - ACLF患者，其中675例有肝硬化，244例无肝硬化。COSSH - ACLF II评分、COSSH - ACLF评分、慢性肝衰竭联盟慢加急性肝衰竭评分（CLIF - C ACLF评分）、同济预后预测模型评分（TPPM评分）、终末期肝病模型评分（MELD评分）以及MELD - 钠评分（MELD - Na评分）均为HBV - ACLF患者短期死亡率的强预测指标。与无肝硬化的ACLF患者中模型具有较高判别能力相比，每种预后模型在预测有肝硬化患者28天或90天预后时，C指数、净重新分类指数（NRI）和综合判别改善指数（IDI）均显著下降。风险分析发现，两个亚组中预后不良的危险因素在很大程度上重叠，而血清胆红素与有肝硬化患者的短期死亡率特异性相关，血尿素氮与无肝硬化患者的短期死亡率特异性相关。对有肝硬化患者的亚组分析显示，与无腹水或感染的患者相比，有腹水或感染患者中CPMs的判别能力下降。
CPMs预测HBV - ACLF短期预后，在无肝硬化患者中效果最佳，但在有肝硬化患者中存在局限性，这至少部分归因于腹水或感染的复杂性。
The accurate prediction of the outcome of hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is impeded by population heterogeneity. The study aimed to assess the impact of underlying cirrhosis on the performance of clinical prediction models (CPMs). Using data from two multicenter, prospective cohorts of patients with HBV-ACLF, the discrimination, calibration, and clinical benefit were assessed for CPMs predicting 28-day and 90-day outcomes in patients with cirrhosis and those without, respectively. A total of 919 patients with HBV-ACLF were identified by Chinese Group on the Study of Severe Hepatitis B (COSSH) criteria, including 675 with cirrhosis and 244 without. COSSH-ACLF IIs, COSSH-ACLFs, Chronic Liver Failure-Consortium Acute-on-Chronic Liver Failure score (CLIF-C ACLFs), Tongji Prognostic Predictor Model score (TPPMs), Model for End-Stage Liver Disease score (MELDs), and MELD-Sodium score (MELD-Nas) were all strong predictors of short-term mortality in patients with HBV-ACLF. In contrast to a high model discriminative capacity in ACLF without cirrhosis, each prognostic model represents a marked decline of C-index, net reclassification index (NRI), and integrated discrimination improvement (IDI) in predicting either 28-day or 90-day prognosis of patients with cirrhosis. The hazard analysis identified largely overlapping risk factors of poor outcomes in both subgroups, while serum bilirubin was specifically associated with short-term mortality in patients with cirrhosis and blood urea nitrogen in patients without cirrhosis. A subgroup analysis in patients with cirrhosis showed a decline of discrimination of CPMS in those with ascites or infections compared to that in those without. Predicting the short-term outcome of HBV-ACLF by CPMs is optimal in patients without cirrhosis but limited in those with cirrhosis, at least partially due to the complicated ascites or infections.
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