Prognostic utility of novel biomarkers in acute-on-chronic liver failure (ACLF) associated with hepatitis B: A multicenter prospective study
Prognostic utility of novel biomarkers in acute-on-chronic liver failure (ACLF) associated with hepatitis B: A multicenter prospective study
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新型生物标志物在乙型肝炎相关慢性肝衰竭（ACLF）中的预后效用：一项多中心前瞻性研究
DOI：
10.1111/hepr.13251
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发表时间：
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影响因子：
4.2
通讯作者：
Shi Y
中科院分区：
文献类型：
--
作者：
Zhao R;Wu W;Zhou Z;Zheng X;Sun W;Shi Y;Yu H;Wang F;Zhao H;Sun S;Jin L;Sheng J;Shi Y
目的慢性B型肝炎的暴发有时可能很严重，甚至进展为慢性加急性肝衰竭（ACLF），短期死亡率很高。应尽早开始及时估计死亡风险。本研究的目的是确定新型生物标志物是否能在当前临床评分系统之外提供预后信息。方法2017年8月至2018年3月期间，从中国五家医院前瞻性招募了B型肝炎相关ACLF患者。筛选其血浆中的可溶性CD 163（sCD 163）、中性粒细胞明胶酶相关脂质运载蛋白（NGAL）和和肽素。分析这些生物标志物与死亡率之间的关联。终末期肝病模型的性能，亚太肝脏ACLF研究协会评分的研究，和慢性肝功能衰竭协会ACLF评分，有或没有生物标志物，进行了比较。晚期ACLF患者的血浆生物标志物sCD 163（P= 0.001）、NGAL（P= 0.006）和和肽素（P= 0.049）水平显著高于早期ACLF患者。在28天随访期内发生了34例死亡（22.5%）。sCD 163和NGAL均显示与28天死亡率有很强的独立相关性，而和肽素则没有。评分系统纳入sCD 163和NGAL有更好的歧视和校准，根据受试者工作特征曲线下的面积，赤池信息标准，综合歧视的改善，和净重新分类improvement.ConclusionsSoluble CD 163和NGAL是独立与短期死亡率B型肝炎相关ACLF。使用sCD 163和NGAL的组合改善粘附。
AimFlare‐ups of chronic hepatitis B can sometimes be severe and even progress to acute‐on‐chronic liver failure (ACLF), with high short‐term mortality. A timely estimation of the risk of death should be initiated early. The aim of the present study was to determine whether novel biomarkers add prognostic information beyond current clinical scoring systems.MethodsPatients with hepatitis B‐associated ACLF were prospectively enrolled from five hospitals in China between August 2017 and March 2018. Their plasma was screened for soluble CD163 (sCD163), neutrophil gelatinase‐associated lipocalin (NGAL), and copeptin. The association between these biomarkers and mortality was analyzed. The performance of the Model for End‐stage Liver Disease, Asian‐Pacific Association for the Study of the Liver–ACLF Research Consortium score, and the Chronic Liver Failure Consortium ACLF score, with or without biomarkers, were compared.ResultsOne hundred fifty one patients were enrolled. Advanced ACLF patients had significantly higher levels than early ACLF individuals of plasma biomarkers sCD163 (P= 0.001), NGAL (P= 0.006), and copeptin (P= 0.049). Thirty‐four deaths occurred during the 28‐day follow‐up period (22.5%). Both sCD163 and NGAL showed a strong independent association with 28‐day mortality, whereas copeptin did not. Scoring systems incorporating sCD163 and NGAL had better discrimination and calibration, as measured by area under the receiver operating characteristic curves, the Akaike information criteria, integrated discrimination improvement, and net reclassification improvement.ConclusionsSoluble CD163 and NGAL are independently associated with short‐term mortality in hepatitis B‐associated ACLF. Use of a combination of sCD163 and NGAL improves prognostication.