新型生物标志物在与乙型肝炎相关的急性慢性肝衰竭（ACLF）

StephenW

Hepatol Res. 2018 Sep 24. doi: 10.1111/hepr.13251. [Epub ahead of print]
Prognostic Utility of Novel Biomarkers in Acute-on-chronic Liver Failure (ACLF) Associated with Hepatitis B: A Multicenter Prospective Study.
Zhao R1, Wu W1, Zhou Z2, Zheng X3, Sun W4, Shi Y5, Yu H1,6, Wang F7, Zhao H1, Sun S1, Jin L1, Sheng J1, Shi Y1.
Author information

1
    State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
2
    Department of Infectious Diseases, Shulan Hospital, Hangzhou, 310004, China.
3
    Department of Hepatology, Ningbo No.2 Hospital, School of Medicine, Ningbo University, Ningbo, 315010, China.
4
    Department of Epidemiology and Health Statistics, Zhejiang University School of Public Health, Hangzhou, 310058, China.
5
    Department of Infectious Diseases, Yuyao People's Hospital, Yuyao, 315400, China.
6
    Department of Infectious Diseases, Yiwu Central Hospital, Yiwu, 322000, China.
7
    Department of Infectious Diseases, Ningbo Beilun People's Hospital, Beilun, 315800, China.

Abstract
BACKGROUND:

Flare-ups of chronic hepatitis B (CHB) can sometimes be severe and even progress to acute-on-chronic liver failure (ACLF), with high short-term mortality. A timely estimation of the risk of death should be initiated early. The aim of the present study was to determine whether novel biomarkers add prognostic information beyond current clinical scoring systems.
METHODS:

Patients with HB-ACLF were prospectively enrolled from five hospitals between August 2017 and March 2018. Their plasma was screened for sCD163, Neutrophil gelatinase-associated lipocalin (NGAL) and copeptin. The association between these biomarkers and mortality was analyzed. And the performance of MELD, APASL-ACLF Research Consortium score (AARC-ACLF score) and the CLIF Consortium ACLF score (CLIF-C ACLFs) with or without biomarkers were compared.
RESULTS:

151 patients were enrolled. Advanced ACLF patients had significantly higher levels than early ACLF individuals of plasma biomarkers sCD163 (P=0.001), NGAL (P=0.006) and copeptin (P=0.049). 34 deaths occurred during the 28-day follow-up period (22.5%). sCD163 and NGAL showed a strong independent association with 28-day mortality, while copeptin did not. Scoring systems incorporating sCD163 and NGAL had better discrimination and calibration, as measured by AuROCs, the Akaike information criteria (AIC), integrated discrimination improvement (IDI) and net reclassification improvement (NRI).
CONCLUSIONS:

sCD163 and NGAL are independently associated with short-term mortality in hepatitis B-associated ACLF. Use of a combination of sCD163 and NGAL improves prognostication.

This article is protected by copyright. All rights reserved.
KEYWORDS:

Acute-on-chronic liver failure (ACLF); Biomarker; Hepatitis B; Prognostication

PMID:
    30246902
DOI:
    10.1111/hepr.13251

StephenW

Hepatol Res。 2018年9月24日doi：10.1111 / hepr.13251。 [提前打印]
新型生物标志物在与乙型肝炎相关的急性慢性肝衰竭（ACLF）中的预后效应：多中心前瞻性研究。
Zhao R1，Wu W1，Zhou Z2，Zheng X3，Sun W4，Shi Y5，Yu H1,6，Wang F7，Zhao H1，Sun S1，Jin L1，Sheng J1，Shi Y1。
作者信息

1
    浙江大学医学院附属第一医院感染性疾病诊断与治疗协同创新中心国家重点实验室，杭州310003
2
    杭州市舒兰医院感染科，310004
3
    宁波大学医学院宁波市第二医院肝病科，宁波315010
4
    浙江大学公共卫生学院流行病与卫生统计学系，杭州310058
五
    余姚市人民医院感染科，浙江余姚315400
6
    义乌市中心医院感染科，义乌​​322000
7
    宁波市北仑人民医院感染科，北仑315800

抽象
背景：

慢性乙型肝炎（CHB）的发作有时可能是严重的，甚至可导致急性慢性肝功能衰竭（ACLF），短期死亡率很高。应尽早开始及时估计死亡风险。本研究的目的是确定新的生物标志物是否增加了超出当前临床评分系统的预后信息。
方法：

在2017年8月至2018年3月期间，从5家医院前瞻性地招募了HB-ACLF患者。对他们的血浆进行sCD163，中性粒细胞明胶酶相关脂质运载蛋白（NGAL）和和肽素的筛选。分析了这些生物标志物与死亡率之间的关联。并且比较了MELD，APASL-ACLF研究联盟评分（AARC-ACLF评分）和CLIF联合ACLF评分（CLIF-C ACLF）与或不与生物标志物的表现。
结果：

招募了151名患者。高级ACLF患者的血浆生物标志物sCD163（P = 0.001），NGAL（P = 0.006）和和肽素（P = 0.049）的早期ACLF患者的水平显着高于早期ACLF患者。在28天的随访期间发生了34例死亡（22.5％）。 sCD163和NGAL显示出与28天死亡率的强烈独立关联，而copeptin没有。结合sCD163和NGAL的评分系统具有更好的区分和校准，如AuROC，Akaike信息标准（AIC），综合鉴别改进（IDI）和净重新分类改进（NRI）所测量。
结论：

sCD163和NGAL与乙型肝炎相关ACLF的短期死亡率独立相关。使用sCD163和NGAL的组合可改善预后。

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关键词：

急性慢性肝功能衰竭（ACLF）;生物标志物;乙型肝炎;预测

结论：
    30246902
DOI：
    10.1111 / hepr.13251