核苷酸类药物对慢加急性肝衰竭患者临床特征、转归及预后的影响

目的探讨核苷酸类药物对慢加急性肝衰竭患者临床特征、转归及预后的影响。方法选取慢加急性肝衰竭患者108例,以随机试验原则分为治疗组与对照组各54例。对照组采用常规内科治疗,治疗组在对照组基础上给予口服核苷酸类药物进行治疗。比较2组患者治疗前后外周血细胞指标(白细胞计数、中性粒细胞、血小板、血红蛋白水平)及凝血功能。对患者年龄、是否存在腹水、肝性脑病及基线HBV-DNA、丙氨酸氨基转移酶、天冬氨酸氨基转移酶及终末期肝病模型(MELD)等因素进行Logistic回归分析,探讨预后的影响因素。结果治疗后,2组外周血白细胞、中性粒细胞较治疗前显著降低,且治疗组效果显著优于对照组(P 0. 05)。治疗后,2组血小板、血红蛋白水平较治疗前显著升高,且治疗组显著优于对照组(P 0. 05)。治疗后,治疗组凝血酶原时间、国际标准化比值显著低于对照组,纤维蛋白原含量显著高于对照组(P 0. 05)。腹水、肝性脑病及MELD评分对患者预后生存状况有显著影响。结论腹水、肝性脑病及MELD评分对患者预后生存状况有显著影响,核苷酸类药物能够有效改善慢加急性肝衰竭患者外周血细胞指标水平及细胞凝血功能。     

慢加急性肝衰竭患者短期预后预测模型的构建与验证

目的 探究慢加急性肝衰竭患者短期预后的预测相关因素,并构建预测模型。方法 选取2021年6月—2022年6月本院收治的100例慢加急性肝衰竭患者为研究对象,通过收集患者治疗期间90 d内的一般情况、生化指标、凝血指标、人工肝治疗及并发症等临床资料,并依据90 d的转归情况将研究对象分为生存组和死亡组,通过多因素logistic回归法分析出患者预后影响因素并构建预测模型,采用受试者工作特征曲线(ROC曲线)评价预测模型。结果 对100例慢加急性肝衰竭患者短期预后进行调查发现,死亡数为36例(36.00%),生存数为64例(64.00%),死亡率较高。构建的CHTIAN模型的AUC值明显高于MELD评分与MELD-Na评分,CHTIAN模型的Youden指数、预测预后生存情况的特异性均优于MELD评分与MELD-Na评分。结论 慢加急性肝衰竭患者伴有肝硬化、伴有肝性脑病、总胆红素(TBil)、国际标准化比值(INR)等均为影响其短期预后的独立危险因素(P<0.05,OR>1);Alb、Na⁺为独立保护性因素,本研究基于以上危险因素建立的预测模型具有良好的预...     

eGFR-CysC联合血栓弹力图对慢加急性肝衰竭患者临床预后的预测价值

目的 探讨胱抑素C估算肾小球滤过率（eGFR-CysC）联合血栓弹力图（TEG）对慢加急性肝衰竭（ACLF）患者临床预后的预测价值。方法 选择34例ACLF患者（ACLF组）、26例慢性肝炎患者（慢性肝炎组）及30例肝硬化患者（肝硬化组）,收集患者的入院24 h内实验室检查指标、TEG参数及eGFR-CysC结果,比较3组患者的各指标差异。对ACLF患者根据是否发生并发症及预后分组,利用二元logistic回归分析影响ACLF患者预后的危险因素,并通过受试者操作特征（ROC）曲线分析相关因素对ACLF患者预后的预测价值。结果 3组患者的白细胞、ALT、总胆红素、白蛋白、CRP、凝血酶原活动度、凝血酶原时间、国际标准化比值以及TEG的反应时间（R）、最大振幅（MA）和eGFR-CysC比较差异均有统计学意义（P均<0.05）。ACLF组内分析显示,MA和eGFR-CysC在有无急性肾损伤组间比较差异有统计学意义（P均<0.05）,R和MA在有无上消化道出血组间比较差异均有统计学意义（P均<0.05）;死亡组与生存组间MA、eGFR-CysC比较差异亦均有统计学意义（P均...     

血浆髓样细胞触发受体2联合终末期肝病模型评分对乙型肝炎病毒相关慢加急性肝衰竭患者近期预后的预测价值

目的 探讨血浆髓样细胞触发受体2(TREM?2)联合终末期肝病模型(MELD)评分对乙型肝炎病毒相关慢加急性肝衰竭(HBV?ACLF)患者近期预后的预测价值.方法 选取2019年1月-2021年1月我院收治的142例HBV?ACLF患者为HBV?ACLF组,随访90 d根据患者结局分为死亡组(n=52)和存活组(n=9...     

应用SOAR评分预测急性缺血性卒中患者短期不良预后风险

目的:探讨国外SOAR评分对我国急性缺血性卒中(AIS)患者短期不良预后的预测价值。方法:前瞻性纳入我科2012年2月至2013年8月住院的AIS患者221例,收集临床相关基线资料并进行SOAR评分,分别以出院和卒中后3个月时功能残障和死亡定义为不良结局事件;通过受试者工作特征曲线下面积(AUC)判断SOAR评分的预测价值;使用Hosmer-Lemeshow法判断模型的拟合优度;应用Pearson相关分析评价实际与预期结局事件的关联程度。结果:出院和3个月时出现不良预后的患者分别为63例(28.5%)和71例(32.1%),死亡9例(4.1%)。SOAR评分在三个结局事件中的AUC分别为0.700、0.705、0.872;灵敏度分别为0.508、0.529、0.889;特异度分别为0.804、0.828、0.741;cut-off临界值为2分。Hosmer-Lemeshow法x2值分别为4.222、2.785、1.045(均P>0.05);Pearson相关系数分别为0.978、0.991、0.914(均P<0.05)。结论:SOAR评分对AIS患者短期不良结局发生风险预测价值较高,评分越高,出现不良预后的风险越大。     

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-ACLFs[OR = 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。     

慢性重型乙型肝炎的终末期肝病模型短期预后分析

目的 评估终末期肝病模型(MELD)评分系统对慢性重型乙型肝炎患者短期(3个月)预后的预测能力及临床应用价值,并求出作为判断患者3个月内生存与否的MELD最佳临界值.方法 将139例慢性重型乙型肝炎患者临床资料按有无肝硬化进行分组,根据MELD评分公式对每位患者进行评分,观察3个月内的病死率,并绘制受试者工作特征曲线(ROC).结果 ①所观察患者的MELD评分均在20分以上,其中慢性重型肝炎组(72例)的MELD评分为(31.34±7.00)分,肝硬化重型肝炎组(67例)的MELD评分为(31.97±6.82)分,两组MELD评分比较差异无显著性(P＞0.05).②139例慢性重型乙型肝炎患者3个月内的总病死率为58.3%(81/139例).MELD评分20～30、30～40和≥40分患者的病死率分别为35.6%(26/73例)、76.6%(36/47例)和100.0%(19/19例),分值越高病死率越高,但MELD评分同一分值段的慢性重型肝炎组与肝硬化重型肝炎组间病死率比较差异均无显著性(P均＞0.05).应用该模型预测患者3个月内死亡与否的MELD最佳临界值为31,ROC下面积为0.809,敏感性为64.2%,特异性为91.4%.结论 患者发病时有无肝硬化的基础可能对慢性重型乙型肝炎患者的短期预后影响不大;MELD评分能够作为反映慢性重型乙型肝炎患者病情严重程度的指标,MELD能够较准确地预测我国慢性重型乙型肝炎患者短期临床预后.     

MELD相关评分体系对乙型肝炎相关慢加急性肝衰竭患者预后的预测价值

目的比较分析MELD、MELD-Na、MELDNa、MESO、iMELD、UKELD六种MELD相关评分体系预测乙型肝炎相关慢加急性肝衰竭(ACHBLF)患者的预后。方法纳入温州医学院附属第一医院327例ACHBLF患者,分别计算各个MELD评分体系值,比较各评分系统在死亡组和生存组中的差异。通过受试者工作特征(ROC)曲线和曲线下面积(AUC)进行比较分析。结果死亡组MELD、MELD-Na、MELDNa、MESO、iMELD、UKELD值分别是29.2±5.6、37.1±12.6、31.1±5.1、26.4±13.8、57.6±23.3、72.8±27.5,虽高于生存组的27.1±6.1、36.3±13.8、29.2±5.8、27.0±16.7、56.1±29.8、70.2±21.4,但除MELD(P=0.02)和MELDNa(P=0.02)评分外,其余差异无统计学意义(P=0.374,P=0.745,P=0.639,P=0.375);各评分系统的AUC分别为0.630、0.556、0.609、0.537、0.555、0.530。结论除MELD和MELDNa评分可能有一定评判价值外,MELD相关评分体系总体上对预测ACHBLF的预后表现较差,无法对ACHBLF进行有效、准确的预测。     

早期凝血酶原活动度对预测慢性乙型肝炎慢加急性肝衰竭预后的价值

目的探讨早期凝血酶原活动度（ PTA）对预测慢性乙型肝炎（ CHB）慢加急性肝衰竭患者预后的价值。方法分析156例CHB相关慢加急性肝衰竭患者3个月的预后,根据临床结局分为生存组和死亡组,分析两组患者在基线、1周及2周时的 PTA 及终末期肝病模型（ MELD）评分的差异,应用受试者工作特征曲线（ ROC曲线）评估基线、1周及2周时的PTA、MELD评分对预后判断的价值。结果在156例患者中有58例死亡,病死率为37.18％。生存组与死亡组患者的PTA （％）比较,在基线、1周及2周时分别为：31.49±7.22 vs 25.44±8.10、37.56±11.72 vs 24.22±11.22及49.28±20.82 vs 23.08±7.43,差异均有统计学意义（ P均＜0.05）;生存组与死亡组患者的MELD评分比较,在基线、1周及2周时分别为：25.53±4.61 vs 28.56±6.39、24.21±4.64 vs 31.07±6.03及20.06±5.06 vs 31.77±6.33,差异均有统计学意义（P均＜0.05）。在基线、1周及2周时PTA、MELD评分的ROC曲线下面积（AUC）比较中,2周时PTA的AUC最大（0.957）,其次为2周时MELD评分的AUC（0.938）,但两者比较差异无统计学意义（P＝0.405）;2周时PTA的最佳临界值为35.55％,敏感度为96.60％,特异度为80.40％。2周时,PTA＜20％的3个月病死率为100％;20％≤PTA＜35％为70.81％;35％≤PTA＜50％为4.17％;PTA≥50％的均存活。 PTA越低,病死率越高,线性趋势检验χ2＝85.70,P＜0.001。结论慢性乙型肝炎慢加急性肝衰竭患者治疗2周时的PTA可作为其3个月预后的早期预测指标。     

乙型肝炎慢加急性肝衰竭38例的中西医结合护理

总结38例乙型肝炎慢加急性肝衰竭患者施行中西医结合治疗的护理。主要护理措施是加强病情观察,督促患者卧床休息,施行灵活饮食护理,结合中西医药物特点细化用药护理。随访48周1例因腹腔感染死亡,37例存活。     

Ammonia predicts poor outcomes in patients with hepatitis B virus-related acute-on-chronic liver failure

BackgroundHepatic encephalopathy (HE) is a common feature of acute liver failure and has been reported to be associated with poor outcomes. Ammonia is thought to be central to the pathogenesis of HE, but its role in hepatitis B virus‐related acute‐on‐chronic liver failure (HBV‐ACLF) is unclear. The present study aimed to assess the prognostic role of ammonia level for patients with HBV‐ACLF.MethodsWe retrospectively recruited 127 patients diagnosed with HBV‐ACLF for the present study.ResultsAmmonia levels at the time of admission were higher among non‐surviving participants than in survivors. Increased ammonia level was found to be associated with severe liver disease and was identified as an independent predictor for mortality in patients with HBV‐ACLF.ConclusionsOur results suggest that high ammonia level at admission is an independent factor for predicting short‐term mortality in patients with HBV‐ACLF. Therefore, ammonia levels may represent a therapeutic target for this condition.     

急诊人工肝治疗乙型病毒性肝炎相关慢加急性肝衰竭预后的研究进展

乙型病毒性肝炎相关慢加急肝衰竭(hepatitis B virus related acute-on-chronic liver failure,HBV-ACLF)具有进展快和死亡率高的特点,人工肝支持系统(artificial liver support system,ALSS)治疗该类患者的疗效远优于标准药物治疗,...     

慢加急性肝衰竭患者发生肺部感染的现状及影响因素研究

目的 探讨乙型肝炎病毒相关慢加急性肝衰竭（HBV related acute-on-chronic liver failure,HBV-ACLF）患者发生肺部感染的现状及其影响因素。 方法 回顾性分析2017年1月—2019年12月于上海市某三级甲等医院传染科住院治疗的238例HBV-ACLF患者的病历资料,统计HBV-ACLF患者发生肺部感染的情况,并分析其影响因素。结果238例HBV-ACLF患者,发生肺部感染患者53例,感染率为22.27%;Logistic回归分析显示,高龄、使用激素、长期使用抗生素是HBV-ACLF患者发生肺部感染的独立危险因素。结论 HBV-ACLF患者年龄越大、使用激素、长期使用抗生素导致其肺部感染率增高,在HBV-ACLF患者的治疗及护理过程中,应结合发生肺部感染的相关影响因素,采取针对性干预措施,从而降低HBV-ACLF患者的肺部感染率。     

Short-term prognostic factors for hepatitis B virus-related acute-on-chronic liver failure

BACKGROUNDAcute-on-chronic liver failure (ACLF) is the abrupt exacerbation of declined hepatic function in patients with chronic liver disease.AIMTo explore the independent predictors of short-term prognosis in patients with hepatitis B virus (HBV)-related ACLF and to establish a predictive short-term prognosis model for HBV-related ACLF.METHODSFrom January 2016 to December 2019, 207 patients with HBV-related ACLF attending the 910th Hospital of Chinese People''s Liberation Army were continuously included in this retrospective study. Patients were stratified based on their survival status 3 mo after diagnosis. Information was collected regarding gender and age; coagulation function in terms of prothrombin time and international normalized ratio (INR); hematological profile in terms of neutrophil-to-lymphocyte ratio (NLR) and platelet count (PLT); blood biochemistry in terms of alanine aminotransferase, aspartate aminotransferase, total bilirubin (Tbil), albumin, cholinesterase, blood urea nitrogen (BUN), creatinine, blood glucose, and sodium (Na); tumor markers including alpha-fetoprotein (AFP) and Golgi protein 73 (GP73); virological indicators including HBV-DNA, HBsAg, HBeAg, Anti-HBe, and Anti-HBc; and complications including hepatic encephalopathy, hepatorenal syndrome, spontaneous peritonitis, gastrointestinal bleeding, and pulmonary infection.RESULTSThere were 157 and 50 patients in the survival and death categories, respectively. Univariate analysis revealed significant differences in age, PLT, Tbil, BUN, NLR, HBsAg, AFP, GP73, INR, stage of liver failure, classification of liver failure, and incidence of complications (pulmonary infection, hepatic encephalopathy, spontaneous bacterial peritonitis, and upper gastrointestinal bleeding) between the two groups (P < 0.05). GP73 [hazard ratio (HR): 1.009, 95% confidence interval (CI): 1.005-1.013, P = 0.000], middle stage of liver failure (HR: 5.056, 95%CI: 1.792-14.269, P = 0.002), late stage of liver failure (HR: 22.335, 95%CI: 8.544-58.388, P = 0.000), pulmonary infection (HR: 2.056, 95%CI: 1.145-3.690, P = 0.016), hepatorenal syndrome (HR: 6.847, 95%CI: 1.930-24.291, P = 0.003), and HBsAg (HR: 0.690, 95%CI: 0.524-0.908, P = 0.008) were independent risk factors for short-term prognosis in patients with HBV-related ACLF. Following binary logistics regression analysis, we arrived at the following formula for predicting short-term prognosis: Logit(P) = Ln(P/1-P) = 0.013 × (GP73 ng/mL) + 1.907 × (middle stage of liver failure) + 4.146 × (late stage of liver failure) + 0.734 × (pulmonary infection) + 22.320 × (hepatorenal syndrome) - 0.529 × (HBsAg) - 5.224. The predictive efficacy of the GP73-ACLF score was significantly better than that of the Model for End-Stage Liver Disease (MELD) and MELD-Na score models (P < 0.05).CONCLUSIONThe stage of liver failure, presence of GP73, pulmonary infection, hepatorenal syndrome, and HBsAg are independent predictors of short-term prognosis in patients with HBV-related ACLF, and the GP73-ACLF model has good predictive value among these patients.     

Clinical characteristics and 28-d outcomes of bacterial infections in patients with hepatitis B virus-related acute-on-chronic liver failure

BACKGROUND Acute-on-chronic liver failure(ACLF),which includes hepatic and multiple extrahepatic organ failure,is a severe emergency condition that has high mortality.ACLF can rapidly progress and requires an urgent assessment of condition and referral for liver transplantation.Bacterial infections(BIs)trigger ACLF and play pivotal roles in the deterioration of clinical course.AIM To investigate the clinical characteristics and 28-d outcomes of first BIs either at admission or during hospitalization in patients with hepatitis B virus(HBV)-ACLF as defined by the Chinese Group on the Study of Severe Hepatitis B(COSSH).METHODS A total of 159 patients with HBV-ACLF and 40 patients with acute decompensation of HBV-related chronic liver disease combined with first BIs were selected for a retrospective analysis between October 2014 and March 2016.The characteristics of BIs,the 28-d transplant-free survival rates,and the independent predictors of the 28-d outcomes were evaluated.RESULTS A total of 194 episodes of BIs occurred in 159 patients with HBV-ACLF.Among the episodes,13.4%were community-acquired,46.4%were healthcare-associated,and 40.2%belonged to nosocomial BIs.Pneumonia(40.7%),spontaneous bacterial peritonitis(SBP)(34.5%),and bloodstream infection(BSI)(13.4%)were the most prevalent.As the ACLF grade increased,the incidence of SBP showed a downward trend(P=0.021).Sixty-one strains of bacteria,including 83.6%Gramnegative bacteria and 29.5%multidrug-resistant organisms,were cultivated from 50 patients with ACLF.Escherichia coli(44.3%)and Klebsiella pneumoniae(23.0%)were the most common bacteria.As the ACLF grade increased,the 28-d transplant-free survival rates showed a downward trend(ACLF-1,55.7%;ACLF-2,29.3%;ACLF-3,5.4%;P<0.001).The independent predictors of the 28-d outcomes of patients with HBV-ACLF were COSSH-ACLF score(hazard ratio[HR]=1.371),acute kidney injury(HR=2.187),BSI(HR=2.339),prothrombin activity(HR=0.967),and invasive catheterization(HR=2.173).CONCLUSION For patients with HBV-ACLF combined with first BIs,pneumonia is the most common form,and the incidence of SBP decreases with increasing ACLF grade.COSSH-ACLF score,acute kidney injury,BSI,prothrombin activity,and invasive catheterization are the independent predictors of 28-d outcomes.     

Outcome scoring systems for short-term prognosis in critically ill cirrhotic patients

Cirrhotic patients admitted to intensive care units (ICUs) have high mortality rates. This study evaluated specific predictors and scoring systems for hospital and 6-month mortality in critically ill cirrhotic patients. This investigation is a prospective clinical study performed in a 10-bed specialized hepatogastroenterology ICU in a tertiary care university hospital in Taiwan. Two hundred two consecutive cirrhotic patients admitted to the ICU during a 2-year period were enrolled in this study. Demographic, clinical, and laboratory variables recorded on the first day of ICU admission and scoring systems applied were prospectively recorded for post hoc analysis for predicting survival. The overall hospital mortality was 59.9%, and the 6-month mortality rate was 70.8%. The main causes of cirrhosis were hepatitis B (29%), hepatitis C (22%), and alcoholism (20%). The major cause of ICU admission was upper gastrointestinal bleeding (36%). Multiple logistic regression analysis revealed that the Acute Kidney Injury Network (AKIN) score at the 48th hour of ICU admission and the Sequential Organ Failure Assessment (SOFA) as well as the Model for End-Stage Liver Disease scores on the first day of ICU admission were independent risk factors for hospital mortality. The SOFA score had the best discriminatory power (0.872 ± 0.036), whereas the AKIN had the best Youden index (0.57) and the highest correctness of prediction (79%). Cumulative survival rates at the 6-month follow-up after hospital discharge differed significantly (P < 0.05) for AKIN stage 0 vs. stages 1, 2, and 3, and for AKIN stage 1 vs. stage 3. The AKIN, SOFA, and Model for End-stage Liver Disease (MELD) scores showed well discriminative power in predicting hospital mortality in this group of patients. The AKIN scoring system proved to be a reproducible evaluation tool with excellent prognostic abilities for these patients.