三种常用指标体系在评估乙型肝炎病毒相关慢加急性肝衰竭患者短期预后中的应用比较

目的探讨预后营养指数（PNI）、抗凝血酶Ⅲ（AT-Ⅲ）、中国重症乙型肝炎研究学组-慢加急性肝衰竭评分（COSSH-ACLFs）模型在乙型肝炎病毒（HBV）相关慢加急性肝衰竭（ACLF）患者病情严重程度及短期预后中的价值。 方法回顾性分析2016年1月至2021年9月在南通大学附属南通第三医院诊治的277例HBV相关ACLF患者的临床资料，根据90 d预后情况，将患者分为好转组（108例）和恶化组（169例）。根据患者入院后24 h内血常规、肝肾功能、凝血功能、肝性脑病分级、平均动脉压、血氧饱和度、吸入氧流量，结合患者年龄，计算出PNI、慢性肝衰竭-慢加急性肝衰竭评分、COSSH-ACLFs。采用Logistic回归分析及受试者工作特征（ROC）曲线评估PNI、AT-Ⅲ、COSSH-ACLFs预测HBV相关ACLF患者90 d短期预后的价值。 结果恶化组COSSH-ACLFs明显高于好转组（Z = 11.189，P<0.001），PNI、AT-Ⅲ水平均明显低于好转组（Z = 6.815、6.000，P均<0.001）。多因素回归分析结果提示PNI比值比（OR）= 0.886，95%置信区间（CI）（0.815，0.963），P = 0.004]、AT-Ⅲ OR = 0.925，95%CI（0.893，0.958），P<0.001]、COSSH-ACLFsOR = 11.456，95%CI（5.700，23.023），P<0.001]为HBV相关ACLF患者90 d预后的独立影响因素。PNI、AT-Ⅲ、COSSH-ACLFs预测HBV相关ACLF患者短期预后的曲线下面积（AUC）分别为0.737、0.720、0.893；三者联合预测模型的预测效能最佳，AUC达到0.926。 结论PNI、AT-Ⅲ、COSSH-ACLFs对预测HBV相关ACLF患者的短期预后具有良好的价值，联合应用预测价值更优。

Comparision of three common index systems in evaluating short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure

ObjectiveTo investigate the value of prognostic nutrition index (PNI), antithrombin Ⅲ (AT-Ⅲ), and Chinese Group on the Study of Severe Hepatitis B-related acute-on-chronic liver failure score (COSSH-ACLFs) in predicting the short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). MethodsA retrospective analysis was proceeded for the clinical date of 277 patients with HBV-ACLF who were diagnosed and treated in the Nantong Third Affiliated Hospital of Nantong University from January 2016 to September 2021. According to the 90-day outcome after diagnosis, patients were divided into an improvement group with 108 patients and a deterioration group with 169 patients. The blood routine, hepatic biological indices, blood coagulation, grade of hepatic encephalopathy, mean arterial pressure, blood oxygen saturation, and oxygen flow within 24 hours after admission were recorded in patients with HBV-ACLF. Combined with ages, PNI, chronic liver failure consortium acute-on-chronic liver failure score, and COSSH-ACLFs were calculated. The receiver operating characteristic curve and the Logistic regression model were used to evaluate the value of PNI, AT-Ⅲ, and COSSH-ACLFs in predicting the 90-day prognosis of patients with HBV-ACLF. ResultsCompared with the improvement group, the COSSH-ACLFs of patients with HBV-ACLF were significantly increased (Z = 11.189, P<0.001), and the levels of PNI and AT-Ⅲ were significantly decreased in the deterioration group (Z = 6.815, 6.000; both P<0.001). Multi-factorial Logistic regression analysis revealed that PNI odds ratio (OR) = 0.886, 95% confidence interval (CI) (0.815, 0.963), P = 0.004], AT-Ⅲ OR = 0.925, 95% CI (0.893, 0.958), P<0.001], and COSSH-ACLFs OR = 11.456, 95%CI (5.700, 23.023), P<0.001] were independent risk factors for short-term prognosis of HBV-ACLF patients. The area under the curve (AUC) of PNI, AT-Ⅲ, and COSSH-ACLFs in predicting the short-term prognosis of HBV-ACLF patients was 0.737, 0.720, and 0.893 respectively. The combined prediction model had the best predictive efficiency, and the AUC could be achieved to 0.926. ConclusionsThe PNI, AT-Ⅲ, and COSSH-ACLFs have good value in evaluating short-term prognosis of patients with HBV-ACLF. Combining these indices has higher predictive value.