A new multiparameter integrated MELD model for prognosis of HBV-related acute-on-chronic liver failure.
A new multiparameter integrated MELD model for prognosis of HBV-related acute-on-chronic liver failure.
复制标题
一种新的多参数综合 MELD 模型用于 HBV 相关慢加急性肝衰竭的预后
DOI：
10.1097/md.0000000000004696
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发表时间：
2016-08
期刊：
影响因子：
1.6
通讯作者：
Gong G
中科院分区：
文献类型：
--
作者：
Luo Y;Xu Y;Li M;Xie Y;Gong G
乙型肝炎病毒相关性急慢性肝衰竭（HBV-ACLF）是最致命的疾病之一。人们提出了许多模型来评估其预后。然而，这些模式仍然存在争议。在本研究中，我们旨在将一些特征纳入终末期肝病（MELD）模型，建立一个新的可靠可行的HBV-ACLF预后模型。接受抗病毒治疗的530例HBV-ACLF患者被纳入回顾性研究，分为训练组（300例）和验证组（230例）。采用Logistic回归分析建立训练队列患者3个月死亡率预测模型，并在验证队列中对新模型进行评价。除MELD评分外，肝性脑病程度（HE）、甲胎蛋白（AFP）、白细胞（WBC）计数、年龄等4个独立因素对HBV-ACLF MELD （HAM）模型也有重要影响：R = 0.174 × MELD + 1.106 × HE−(0.003 × AFP) + (0.237 × WBC) + (0.103 × age)−11.388。训练组和验证组的接受者-工作特征曲线下面积分别为0.894和0.868，显著高于其他7个模型。HAM的最佳截断值为- 1.191，具有较高的敏感性和阴性预测值。我们开发了一个新的模型，对HBV-ACLF患者的3个月死亡率具有很大的预后价值。
AbstractHepatitis B virus related acute-on-chronic liver failure (HBV-ACLF) is one of the most deadly diseases. Many models have been proposed to evaluate the prognosis of it. However, these models are still controversial. In this study, we aimed to incorporate some characters into model for end-stage liver disease (MELD) to establish a new reliable and feasible model for the prognosis of HBV-ACLF.A total of 530 HBV-ACLF patients who had received antiviral therapy were enrolled into a retrospective study and divided into the training cohort (300) and validation cohort (230). Logistic regression analysis was used to establish a model to predict the 3-month mortality from the patients in the training cohort, and then, the new model was evaluated in the validation cohort.Except for MELD score, 4 other independent factors, namely degree of hepatic encephalopathy (HE), alpha-fetoprotein (AFP), white blood cell (WBC) count, and age, were important for the new model called HBV-ACLF MELD (HAM) model: R = 0.174 × MELD + 1.106 × HE − (0.003 × AFP) + (0.237 × WBC) + (0.103 × Age) − 11.388. The areas under receiver-operating characteristic curve of HAM in the training and validation cohort were 0.894 and 0.868, respectively, which were significantly higher than those of other 7 models. With the best cut-off value of −1.191, HAM achieved higher sensitivity and negative predictive value.We developed a new model that has a great prognostic value of the 3-month mortality of patients with HBV-ACLF.