提示：一种新的预后模型，用于乙型肝炎病毒相关的急性慢

StephenW

HINT: a novel prognostic model for patients with hepatitis B virus‐related acute‐on‐chronic liver failure
Daxian Wu
Zeyu Sun
Xiaoli Liu
Qunfang Rao
Wenqian Chen
Jie Wang
Zhongyang Xie
Sainan Zhang
Zhengyi Jiang
Er'mei Chen
Kaizhou Huang
Chenxia Hu
… See all authors
First published: 01 August 2018
https://doi.org/10.1111/apt.14927

The Handling Editor for this article was Professor Geoffrey Dusheiko, and it was accepted for publication after full peer‐review.

Daxian Wu, Zeyu Sun, and Xiaoli Liu contributed to this paper equally.
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Summary
Background

HBV related acute‐on‐chronic liver failure (HBV‐ACLF) deteriorates rapidly in short term, which necessitates accurate initial clinical decision‐making.
Aims

To develop a novel prognostic score for patients with HBV‐ACLF and clarify the role of thyroid hormones in HBV‐ACLF.
Methods

A retrospective cohort of 635 HBV‐ACLF patients was enrolled to develop and validate a novel prognostic score for HBV‐ACLF. Additionally, a cross‐sectional cohort (n = 199) and a prospective longitudinal HBV‐ACLF cohort (n = 56) were recruited to clarify the association between thyroid hormone status and the 30‐day mortality of HBV‐ACLF.
Results

HINT, a novel prognostic score based on hepatic encephalopathy, INR, neutrophil count, and thyroid‐stimulating hormone (TSH) using the deriving cohort (n = 426), was significantly higher in nonsurvivors than survivors (1.17 ± 2.38 vs −1.87 ± 1.26, P < 0.0001). The AUROC of HINT for 30‐day mortality was 0.889, which was significantly higher than that of the Child‐Pugh, MELD, CLIF‐SOFA, CLIF‐C ACLF, and COSSH‐ACLF scores (all P < 0.05). These results were confirmed in the validation cohort (n = 209), except that the AUROC of HINT was comparable to that of COSSH‐ACLF (P = 0.357). Among thyroid hormones, only the TSH level on admission was significantly lower in nonsurvivors than in survivors (P = 0.01). During the 14‐day longitudinal observation, TSH levels increased significantly in the improvement group (P < 0.001) but did not change in the deterioration or fluctuation groups, and gradually increased in survivors (P < 0.001) but not in nonsurvivors.
Conclusions

HINT, as a prognostic score for HBV‐ACLF, is simpler than and superior to the Child‐Pugh, MELD, CLIF‐SOFA, and CLIF‐C ACLF scores and at least comparable with the COSSH‐ACLF score. Sequential TSH measurements may facilitate prediction of the clinical course of ACLF.

StephenW

提示：一种新的预后模型，用于乙型肝炎病毒相关的急性慢性肝衰竭患者
吴达贤
泽宇太阳
刘小莉
群芳饶
陈文谦
王杰
中央谢
张南
郑义强
陈二梅
黄凯州
陈霞霞
......见所有作者
首次发布：2018年8月1日
https://doi.org/10.1111/apt.14927

本文的处理编辑器是Geoffrey Dusheiko教授，经过全面的同行评审后被接受发表。

吴达贤，孙泽宇和刘晓莉平等地为本文做出了贡献。
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概要
背景

HBV相关的急性慢性肝衰竭（HBV-ACLF）在短期内迅速恶化，这需要准确的初步临床决策。
目标

为HBV-ACLF患者制定新的预后评分，并阐明甲状腺激素在HBV-ACLF中的作用。
方法

一项由635名HBV-ACLF患者组成的回顾性队列研究开发并验证了HBV-ACLF的新预后评分。此外，招募横断面队列（n = 199）和前瞻性纵向HBV-ACLF队列（n = 56）以阐明甲状腺激素状态与HBV-ACLF的30天死亡率之间的关联。
结果

提示，使用衍生队列（n = 426），基于肝性脑病，INR，中性粒细胞计数和促甲状腺激素（TSH）的新预后评分在非存活者中显着高于存活者（1.17±2.38 vs -1.87±1.26） ，P <0.0001）。 30天死亡率的AUROC为0.889，显着高于Child-Pugh，MELD，CLIF-SOFA，CLIF-C ACLF和COSSH-ACLF评分（均P <0.05）。这些结果在验证组（n = 209）中得到证实，除了HINT的AUROC与COSSH-ACLF的AUROC相当（P = 0.357）。在甲状腺激素中，入院时仅TSH水平显着低于幸存者（P = 0.01）。在14天的纵向观察中，改善组的TSH水平显着增加（P <0.001），但在恶化或波动组中没有变化，并且在幸存者中逐渐增加（P <0.001），但在非幸存者中没有。
结论

作为HBV-ACLF的预后评分，该指标比Child-Pugh，MELD，CLIF-SOFA和CLIF-C ACLF评分更简单，并且至少与COSSH-ACLF评分相当。顺序TSH测量可以有助于预测ACLF的临床过程。

StephenW

https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.14927