Development of a Widely Applicable and Simple Prognostic Score for Patients with Acute-on-chronic Liver Failure.
Development of a Widely Applicable and Simple Prognostic Score for Patients with Acute-on-chronic Liver Failure.
复制标题
为慢加急性肝衰竭患者制定广泛适用且简单的预后评分
DOI：
10.14218/jcth.2021.00328
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发表时间：
2022-10-28
影响因子：
3.6
通讯作者：
中科院分区：
文献类型：
--
作者：
慢性加急性肝衰竭（ACLF）进展迅速，短期死亡率高。我们的目的是为ACLF患者创建一个广泛适用的简单预后（WASP）评分。方法采用回顾性队列研究方法，将中国3个中心的ACLF病例分为训练集和验证集，以开发新的评分。招募了一个前瞻性纵向队列进行进一步验证。结果共纳入541例ACLF患者，筛选出7个独立的ACLF预后因素，构建了一个新的WASP-ACLF量化表。在671例病例的验证集中，WASP-ACLF对28天和90天死亡率的预测能力优于目前使用的基线、第3天、第1周和第2周的预后评分。随着时间的推移，该模型的预测功效和临床有效性得到改善。根据WASP-ACLF评分将患者分为低、中、高风险组。与其他两组相比，中危患者的预后更不确定，90天死亡率为44.4 - 50.6%。第1周和第2周的序贯评估发现，对于WASP-ACLF降低≥ 2分的患者，中危组的90天死亡率<20%，而对于WASP-ACLF升高≥ 2分的患者，中危组的90天死亡率高达56%。在前瞻性数据中观察到类似的结果。结论新的ACLF预后评分方法简便、适用范围广、预测效果好。需要考虑WASP-ACLF的持续评估和变化趋势，特别是对于中危患者。
Background and Aims Acute-on-chronic liver failure (ACLF) tends to progress rapidly with high short-term mortality. We aimed to create a widely applicable, simple prognostic (WASP) score for ACLF patients. Methods A retrospective cohort of ACLF cases recruited from three centers in China were divided into training and validation sets to develop the new score. A prospective longitudinal cohort was recruited for further validation. Results A total of 541 cases were included in the training set, and seven independent ACLF prognostic factors were screened to construct a new quantitative WASP-ACLF table. In the validation set of 671 cases, WASP-ACLF showed better predictive ability for 28-day and 90-day mortality than the currently used prognostic scores at baseline, day 3, week 1, and week 2. The predictive efficacy and clinical validity of the model improved over time. Patients were assigned to low-, intermediate-, and high-risk groups by their WASP-ACLF scores. Compared with the other two groups, intermediate-risk patients had a more uncertain prognosis, with a 90-day mortality of 44.4–50.6%. Sequential assessments at weeks 1 and 2 found the 90-day mortality of intermediate-risk groups was <20% for patients with a ≥2 point decrease in WASP-ACLF and was up to 56% for patients with a ≥2 points increase. Similar results were observed in prospective data. Conclusions The new ACLF prognostic score was simple, widely applicable, and had good predictive efficacy. Continuous assessments and trend of change in WASP-ACLF need to be considered, especially for intermediate-risk patients.