Referral system has a diminished difference in the risk for hepatic encephalopathy development among each etiology in patients with acute liver injury.
Referral system has a diminished difference in the risk for hepatic encephalopathy development among each etiology in patients with acute liver injury.
复制标题
转诊系统减少了急性肝损伤患者中每种病因发生肝性脑病的风险差异。
DOI：
10.1111/hepr.13744
复制
发表时间：
2022
期刊：
影响因子：
4.2
通讯作者：
Takikawa Y.
中科院分区：
文献类型：
--
作者：
Kakisaka K;Suzuki Y;Takahashi F;Takikawa Y.
肝性脑病（HE）的发展对急性肝损伤（ALI）和肝衰竭（ALF）患者的肝移植至关重要；为了预测HE的发展，2004年建立了日本肝性脑病预测（JHEP）模型，该模型使用年龄、病因、凝血酶原时间（PT）和总胆红素进行计算，并从2004年4月开始使用JHEP模型实施肝脏中心转诊系统。方法利用来自转诊系统的数据，对2004年4月至2021年1月期间460例ALI患者的JHEP模型预测HE发展的能力进行评估，并对JHEP模型进行修订。结果观察期内，7.8%的患者发生HE。不同病因间HE发展比例无差异。在HE发展预测的Hosmer-Lemeshow检验中，JHEP模型、不计算病因学数据的修正JHEP （rJHEP）模型和使用PT国际比率代替rJHEP模型中的PT的修正JHEP模型均为较好的拟合模型。从患者总数中抽取30%随机抽样60次，在所有数据集中对JHEP和rJHEP模型进行HE发展的受试者工作曲线分析。JHEP模型曲线下面积减去rJHEP模型曲线下面积（95%置信区间，0.000516-0.01793）。结论采用JHEP模型的转诊系统降低了不同病因间HE发展风险的差异；rJHEP模型对HE发展的预测能力优于JHEP模型。
AimHepatic encephalopathy (HE) development is crucial in liver transplantation for patients with acute liver injury (ALI) and failure (ALF); to predict HE development, the Japan Hepatic Encephalopathy Prediction (JHEP) model, calculated using age, etiology, prothrombin time (PT), and total bilirubin, was established in 2004, and a referral system to the liver center was implemented using the JHEP model from April 2004.MethodsThe JHEP model's ability to predict HE development in 460 consecutive patients with ALI between April 2004 and January 2021 using data from the referral system was evaluated, and the JHEP model was revised.ResultsDuring the observation period, 7.8% patients developed HE. There was no difference in the proportion of HE development among the etiologies. In the Hosmer–Lemeshow test for HE development prediction, the JHEP model, revised JHEP (rJHEP) model, which was calculated without etiology data, and the modified JHEP model, which used the PT international ratio instead of PT in the rJHEP model, were good fitting models. Upon 30% random sampling from the total patients 60 times, the receiver operating curve analysis of both JHEP and rJHEP models for HE development was performed in all the datasets. The area under the curve of the JHEP model was subtracted from that of the rJHEP model (95% confidential interval, 0.000516–0.01793).ConclusionsThe referral system using the JHEP model reduced the difference in the risk for HE development among each etiology; the rJHEP model had a better prediction ability for HE development than the JHEP model.