不同评分系统对乙型肝炎相关慢加急性肝衰竭短期预后的诊断价值.

Abstract：Objective To investigate the diagnostic values of model of end-stage with incorporation of serum sodium (MELD- Na) score, chronic liver failure- sequential organ failure assessment (CLIF- SOFA) score and APASL- ACLF research consortium score (AARC-ACLF) for evaluation of prognosis of hepatitis B virus related acute-on-chronic liver failure (HBV- ACLF). Methods A total of 72 consecutive patients with HBV- ACLF were included in the study and divided into two groups (group A and group B) according to the prognosis in three-month. Group A were included 29 patients with stable disease or better after medical treatment at least for 3 months, and group B included 43 patients who were dead after treatment or received liver transplantation as failure of medical treatment. When the patients were diagnosed as ACLF or after admission, the data were collected. Results of the laboratory examination were collected when the international normalized ratio (INR) was minimum. Data of total bilirubin (TBIL), prothrombin time (PT), INR, serum creatinine (Cr), serum sodium (Na), albumin (ALB), MELD-Na, CLIF-SOFA and AARC-ACLF scores were calculated respectively. The comparative analysis was performed. Areas under the receiver operating characteristic curve (AUC-ROC) of MELD-Na and CLIF-SOFA scores were used to assess the short-term prognosis in patients with acute-on-chronic liver failure. Results The values of TBIL, INR, MELD-Na, AARC-ACLF and CLIF-SOFA were significantly higher in group B than those in group A (P＜0.05). The serum level of Na was significantly lower in group B than that of group A (P＜0.05). The area under curve (AUC) values generated by the ROC curves was higher for CLIF-SOFA score (AUC 0.887) than that of MELD-Na score (AUC 0.764) (Z=2.255, P＜0.016 7). The AUC values generated by the ROC curves showed no significant differences between CLIF-SOFA score and AARC-ACLF score (AUC 0.825) or MELD-Na score and AARC-ACLF score (Z=1.361, 1.127, P＞0.016 7). The cut- off scores of MELD- Na, CLIF- SOFA and AARC- ACLF were 23.84, 8.50 and 8.50 respectively. Conclusion MELD- Na, CLIF- SOFA and AARC- ACLF scores have appreciable values to evaluate the prognosis in patients with HBV-related ACLF. AARC-ACLF is better than that of MELD-Na and CLIF-SOFA in assessing prognosis of HBV-related ACLF. [ABSTRACT FROM AUTHOR]