慢加急性肝衰竭患者发生肝性脑病高危人群的分类树模型和简易风险评估

目的 基于分类树模型对乙型肝炎相关慢加急性肝衰竭患者发生肝性脑病的影响因素和高危人群进行研究,建立评估慢加急性肝衰竭患者发生肝性脑病风险的分类树模型和简易风险评估表。方法 收集2010年1月—2018年6月在佛山市第一人民医院感染科、江门市中心医院感染科和南方医科大学顺德医院感染性疾病科住院治疗的乙型肝炎相关慢加急性肝衰竭患者的临床资料,利用分类树模型探索肝性脑病的影响因素和高危人群。结果 多因素logistic回归分析提示年龄（回归系数=0.035,P=0.001,OR=1.036）、肝肾综合征（回归系数=1.295,P=0.023,OR=3.650）和Model for end-stage liver disease (MELD）评分（回归系数=0.750,P=0.003,OR=2.117）为慢加急性肝衰竭患者发生肝性脑病的独立影响因素。分类树模型提示慢加急性肝衰竭患者发生肝性脑病和MELD评分、年龄有关。通过MELD评分和年龄可建立评估慢加急性肝衰竭患者发生肝性脑病风险的简易风险评估表。结论 通过多因素logistic回归分析和分类树模型发现慢加急性肝衰竭患者发生肝性脑病和MELD评分、年龄关系密切,根据这2个指标建立的分类树模型和简单风险评估表可用于评估慢加急性肝衰竭患者发生肝性脑病的风险。

Classification tree model and simple risk assessment table for hepatic encephalopathy in patients with hepatitis B related acute on chronic liver failure

Objective To study the risk factors and high risk population of hepatic encephalopathy in patients with hepatitis B related acute on chronic liver failure (ACLF) by using classification tree method, and we build a simple risk assessment table for hepatic encephalopathy in ACLF patients. Methods The eligible ACLF patients from the Department of Infectious Diseases of three hospitals including The Jiangmen Central Hospital, The First People's Hospital of Foshan and Shunde Hospital of Southern Medical University from January 2010 to June 2018 were included in the current study. The classification tree model was used to explore the risk factors and high risk population of hepatic encephalopathy. Results Logistic regression analysis demonstrated that age r=0.035, P=0.001, odds ratio(OR)=1.036], hepatic encephalopathy (r=1.295, P =0.023, OR=3.650) and model for end-stage liver disease (MELD) score (r=0.750, P =0.003, OR=2.117) might be the independent factors of hepatic encephalopathy in ACLF patients. The classification tree model indicated that MELD score and age were the influence factors of hepatic encephalopathy in ACLF patients. The MELD score and age could be used to establish a simple risk assessment table to assess the risk of hepatic encephalopathy in ACLF patients. Conclusion Hepatic encephalopathy in ACLF patients is correlated with MELD score and age by using Logistic regression analysis and classification tree method. A simple risk assessment table can be used to evaluate the risk of hepatic encephalopathy in ACLF patients.