模型预测慢性HBV急性肝衰竭进展

StephenW

Model predicts progression to acute liver failure in chronic HBV

Ren Y, et al. Hepatol Res. 2017;doi:10.1111/hepr.13062.
January 23, 2018

A new prediction model revealed that hepatitis B DNA, international normalized ratio and older age correlated with an increased risk for the development of acute-on-chronic liver failure in patients with acute exacerbation of chronic HBV.

“During the natural course of chronic HBV infection, most patients will experience hepatitis flares with various degrees of liver injury,” researchers from the department of infectious disease, Affiliated Hospital of Zunyi Medical Center, Guizhou, China, wrote. “Patients with [acute exacerbation] of chronic HBV infection are at risk of further deterioration and progression to hepatic decompensation and acute-on-chronic liver failure (ACLF).”
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The study comprised 474 patients with acute exacerbation of chronic HBV. Thirty-six patients progressed to ACLF after hospital admission, 15 of whom died during 3 months of follow-up.

Investigators randomly assigned patients into a derivation cohort (n = 280) and a validation cohort (n = 194) for the final model. Patients in the derivation cohort had higher levels of albumin and prealbumin and were more likely to have cirrhosis compared with the validation cohort. Otherwise, clinical characteristics were comparable between the two groups.

In the derivation cohort, patients who developed ACLF were more likely to be older (43.7 vs. 37.4 years; P = .012), have higher levels of HBV DNA (7.5 vs. 6.1 log copies/mL; P = .001), total bilirubin (211.2 vs. 133.3 mol/L; P = .032) and international normalized ratio (1.59 vs. 1.23; P < .0005), and have lower levels of prealbumin (47.5 vs. 70 mg/L; P = .009), sodium (135.6 vs. 137.2 mmol/L; P = .012) and prothrombin activity (46.5% vs. 70.3%; P < .0005) compared with those without ACLF.

Univariate analysis showed that age, HBV DNA, total bilirubin, INR, prealbumin, prothrombin activity and sodium levels correlated significantly with progression to ACLF. However, after multivariate analysis only age (OR = 1.054; 95% CI, 1.004-1.107), HBV DNA (OR = 1.705; 95% CI, 1.105-2.631) and INR (OR = 37.74; 95% CI, 6.7-211.2) remained significant factors.

The data indicate this model better predicted ACLF progression (AUROC = 0.867; 95% CI, 0.781-0.9954) compared with MELD score (AUROC = 0.706; 95% CI, 0.577-0.834) and MELD-Na score (AUROC = 0.7; 95% CI, 0.575-0.824). With a cut-off value of –2.43, the model also achieved a higher sensitivity (85%), specificity (80%), positive predictive value (24.6%) and negative predictive value (99.6%) compared with MELD and MELD-Na score.

Results from the validation cohort showed the model continued to produce better results (AUROC = 0.827; 95% CI, 0.766-0.877) than MELD score (AUROC = 0.678; 95% CI, 0.607-0.743) or MELD-Na score (AUROC = 0.667; 95% CI, 0.596-0.733). With the cut-off value of –2.43, the model achieved a higher sensitivity (87.5%), specificity (73.6%), positive predictive value (23%) and negative predictive value (98.5%) than MELD or MELD-Na score.

“Although all patients in our study had started antiviral therapy after admission, baseline HBV DNA level was found to be one of only three independent risk factors,” the researchers wrote. “Our results provide further evidence to support the hypothesis that baseline HBV DNA level plays an important role in determining progression in [acute exacerbation] patients despite early antiviral treatment.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.

StephenW

模型预测慢性HBV急性肝衰竭进展

Ren Y，et al。 Hepatol Res。 2017; DOI：10.1111 / hepr.13062。
2018年1月23日

一项新的预测模型显示，乙型肝炎DNA，国际标准化比率和年龄较大与慢性乙型肝炎急性加重患者发生急性慢性肝衰竭的风险增加相关。

“在慢性乙型肝炎感染的自然过程中，大多数患者会出现不同程度肝损伤的肝炎，”贵州遵义医学中心附属医院传染病研究人员写道。 “慢性HBV感染[急性加重]的患者有进一步恶化和进展为肝功能失代偿和慢性肝衰竭（ACLF）的风险。”
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该研究包括474例急性加重慢性HBV的患者。入院后36例患者进展为ACLF，其中15例在随访3个月后死亡。

研究者随机将患者分为派生组（n = 280）和验证队列（n = 194）作为最终模型。派生队列中的患者与验证队列相比具有更高水平的白蛋白和前白蛋白，并且更可能患有肝硬化。否则，两组的临床特征相当。

在推导队列中，发生ACLF的患者更可能年龄更大（43.7 vs 37.4岁; P = 0.012），HBV DNA水平更高（7.5比6.1 log拷贝/ mL; P = 0.001），总胆红素（211.2 vs. 133.3 mol / L; P = 0.032）和国际标准化比值（1.59 vs. 1.23; P <0.0005），前白蛋白水平较低（47.5 vs. 70 mg / L; P = 009），钠（135.6vs137.2mmol / L; P = 0.012）和凝血酶原活性（46.5％比70.3％; P <0.0005）。

单因素分析显示年龄，HBV DNA，总胆红素，INR，前白蛋白，凝血酶原活动度和钠水平与ACLF进展显着相关。然而，经过多因素分析（OR = 1.054; 95％CI，1.004-1.107）后，HBV DNA（OR = 1.705; 95％CI，1.105-2.631）和INR（OR = 37.74; 95％CI，6.7-211.2 ）仍然是重要的因素。

数据表明，与MELD评分（AUROC = 0.706; 95％CI，0.577-0.834）和MELD-Na评分（AUROC = 0.7; 95）相比，该模型更好地预测ACLF进展（AUROC = 0.867; 95％CI，0.781-0.9954） ％CI，0.575-0.824）。与MELD和MELD-Na相比，该模型的截止值为-2.43，敏感性（85％），特异性（80％），阳性预测值（24.6％）和阴性预测值（99.6％得分了。

来自验证队列的结果显示模型比MELD得分（AUROC = 0.678; 95％CI，0.607-0.743）或MELD-Na得分（AUROC = 0.827; 95％CI，0.766-0.877） 0.667; 95％CI，0.596-0.733）。与MELD或MELD-Na评分相比，该模型的截止值为-2.43，敏感性高（87.5％），特异性（73.6％），阳性预测值（23％）和阴性预测值（98.5％）。

研究人员写道，虽然我们研究中的所有患者在入院后都开始抗病毒治疗，但发现基线HBV DNA水平是仅有的三个独立危险因素之一。 “我们的研究结果提供了进一步的证据来支持基线HBV DNA水平在确定[急性加重]患者进展中起重要作用，尽管早期抗病毒治疗。” - Talitha Bennett

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