Prediction of the prognosis after liver transplantation in severe hepatitis B-induced liver failure and clinical decision for liver transplantation.
Prediction of the prognosis after liver transplantation in severe hepatitis B-induced liver failure and clinical decision for liver transplantation.
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乙型肝炎所致重症肝功能衰竭肝移植术后预后预测及肝移植的临床决策。
DOI：
10.1016/j.jss.2013.01.034
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Zhan
中科院分区：
文献类型：
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作者：
Xing Yang;Q. Lu;Tengqian Tang;R. Liao;Zhan
研究背景重型乙型肝炎肝衰竭（SHBLF）患者需要肝移植是一个特殊的挑战。我们试图探索预后因素，并建立一个新的评分模型，SHBLF预后模型（SHBLFPM），这可以帮助临床decisionmaking.Materials and MethodsA共98例接受肝移植SHBLF在我们的中心回顾性招募1999年1月1日至2010年12月31日。采用考克斯比例风险模型和对数秩检验分析临床和生化数据。获得了国王学院医院（KCH）标准、终末期肝病模型（MELD）和新模型的受试者工作特征曲线;结果患者年龄是影响预后的独立因素（AP，P= 0.017），肝性脑病血清总胆红素浓度（HE，P= 0.013）（TBiL，P< 0.001）和凝血酶原时间的国际标准化比率（INR，P= 0.001），如使用多变量考克斯回归分析所确定的。新回归模型的曲线下面积（0.881）明显大于MELD（0.783）和KCH评分（0.596）（P< 0.05）。术前SHBLF FPM评分<23.57者预后明显好于评分高者（P< 0.001）。结论患者年龄、肝性脑病、血清总胆红素浓度、凝血酶原时间国际标准化比值是影响SHBLF患者移植术后死亡率的独立因素。SHBLF FPM模型比MELD模型和KCH模型具有更高的预后预测能力，可作为临床决定SHBLF患者肝移植的标准。
BackgroundSevere hepatitis B–induced liver failure (SHBLF) patients who require liver transplantation represent a particular challenge. We sought to explore the prognostic factors and establish a new scoring model, the SHBLF prognosis model (SHBLFPM), which can aid in clinical decision making.Materials and methodsA total of 98 patients who underwent liver transplantation for SHBLF in our center were retrospectively recruited between January 1, 1999, and December 31, 2010. The clinical and biochemical data were analyzed using the Cox proportional hazards model and log-rank test. The receiver operating characteristic curves were obtained for the King's College Hospital (KCH) criterion, the model for end-stage liver disease (MELD), and the new model; the areas under the curves were compared using az-test.ResultsThe independent factors predicting the prognosis were the age of the patient (AP,P= 0.017), hepatic encephalopathy (HE,P= 0.013), the serum total bilirubin concentration (TBiL,P< 0.001), and the international normalized ratio for prothrombin time (INR,P= 0.001), as identified using a multivariate Cox regression analysis. The area under the curve of the new regression model (0.881) was significantly larger than that of the MELD (0.783) and KCH scores (0.596) (P< 0.05). Patients with a preoperative SHBLFPM score <23.57 had a significantly better prognosis than those with higher scores (P< 0.001).ConclusionsAge of patient, hepatic encephalopathy, serum total bilirubin concentration, and international normalized ratio for prothrombin time are independent factors affecting the posttransplantation mortality of SHBLF patients. SHBLFPM may be a criterion for the clinical decision for liver transplantation in SHBLF patients with a greater prognostic predictive ability than the MELD and KCH models.