Δ总胆红素-甲胎蛋白评分模型对HBV相关慢加急性肝衰竭短期预后的预测价值OA北大核心CSTPCD

Objective To investigate the association of the dynamic changes of serum total bilirubin(ΔTBil)and alpha-fetoprotein(AFP)with the short-term prognosis of patients with hepatitis B virus-associated acute-on-chronic liver failure(HBV-ACLF),to establish a new scoring model,and to investigate the value of this model in evaluating the short-term prognosis of HBV-ACLF through comparison with Model for End-Stage Liver Disease(MELD)score and other scoring systems.Methods The patients with HBV-ACLF who were hospitalized and treated in Department of Gastroenterology,The General Hospital of Western Theater Command,from January 2015 to December 2022 were enrolled as the retrospective study cohort.Clinical data within 24 hours after admission were collected from all patients,and the patients were divided into survival group and death group according to the survival after 90 days of follow-up.The independent-samples t test was used for comparison of normally distributed continuous data between groups;the Mann-Whitney U test was used for comparison of continuous data with skewed distribution between groups;the chi-square test or the corrected chi-square test was used for comparison of categorical data between two groups.A multivariate Logistic regression analysis was used to determine the risk factors for the prognosis of HBV-ACLF patients and establish a predictive model for prognosis,and the receiver operating characteristic(ROC)curve was used to investigate the value of the new model in predicting the short-term prognosis of HBV-ACLF patients.Results A total of 361 patients were included in the analysis,with a 90-day survival rate of 67.3%(243/361).Compared with the survival group(n=243),the death group(n=118)had significantly higher age,incidence rates of upper gastrointestinal bleeding and hepatic encephalopathy,international normalized ratio,prothrombin time(PT),leukocytes,monocytes,neutrophils,creatinine,ΔTBil,MELD score,and ALBI score(all P<0.05),as well as significantly lower levels of total cholesterol,high-density lipoprotein,low-density lipoprotein,albumin,AFP,platelet count,lymphocytes,and Na+(all P<0.05).The multivariate Logistic regression analysis showed that AFP,PT,Na+,and ΔTBil were independent influencing factors for the 90-day prognosis of patients with HBV-ACLF(all P<0.05).The new ΔTBil-AFP scoring model was established as 11.987+1.168×ΔTBil(%)-0.095×Na+(mmol/L)+0.25×PT(s)-0.002×AFP(ng/mL),which had a relatively high predictive value,with an area under the ROC curve of 0.796,a sensitivity of 0.766,and a specificity of 0.723,and the decision curve showed good benefits.Conclusion Compared with the commonly used prediction models such as MELD score and ALBI score,the ΔTBil-AFP scoring model has a better prediction performance.