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王鹭, 吴晓娟, 蔡蓓, 等. 胱抑素C估算肾小球滤过率对人工肝治疗HBV相关性慢加急性肝衰竭短期预后的预测价值[J]. 四川大学学报(医学版), 2021, 52(5): 862-867. DOI: 10.12182/20210660104
引用本文: 王鹭, 吴晓娟, 蔡蓓, 等. 胱抑素C估算肾小球滤过率对人工肝治疗HBV相关性慢加急性肝衰竭短期预后的预测价值[J]. 四川大学学报(医学版), 2021, 52(5): 862-867. DOI: 10.12182/20210660104
WANG Lu, WU Xiao-juan, CAI Bei, et al. Clinical Value of Cystatin C-Based Estimated Glomerular Filtration Rate in Assessing Short-Term Mortality in Patients with Hepatitis B Virus-Related Acute-on-Chronic Liver Failure Treated with Artificial Liver Support System[J]. Journal of Sichuan University (Medical Sciences), 2021, 52(5): 862-867. DOI: 10.12182/20210660104
Citation: WANG Lu, WU Xiao-juan, CAI Bei, et al. Clinical Value of Cystatin C-Based Estimated Glomerular Filtration Rate in Assessing Short-Term Mortality in Patients with Hepatitis B Virus-Related Acute-on-Chronic Liver Failure Treated with Artificial Liver Support System[J]. Journal of Sichuan University (Medical Sciences), 2021, 52(5): 862-867. DOI: 10.12182/20210660104

胱抑素C估算肾小球滤过率对人工肝治疗HBV相关性慢加急性肝衰竭短期预后的预测价值

Clinical Value of Cystatin C-Based Estimated Glomerular Filtration Rate in Assessing Short-Term Mortality in Patients with Hepatitis B Virus-Related Acute-on-Chronic Liver Failure Treated with Artificial Liver Support System

  • 摘要:
      目的  探讨胱抑素C估算肾小球滤过率(cystatin C-based estimated glomerular filtration rate, eGFR-CysC)对人工肝治疗的乙型肝炎病毒相关性慢加急性肝功能衰竭(hepatitis B virus-related acute-on-chronic liver failure, HBV-ACLF)预后的预测价值。
      方法  回顾性收集我院364例人工肝治疗的HBV-ACLF住院患者,根据28 d死亡率将患者分为存活组269例和死亡组95例,分析临床资料和实验室数据对患者短期预后的价值。
      结果  多因素Cox回归分析显示,基线eGFR-CysC水平低是HBV-ACLF患者28 d死亡率的独立风险因素之一(风险比=0.987;95%置信区间:0.979~0.996,P=0.003)。基线eGFR-CysC水平与终末期肝病模型评分(the model for end-stage liver disease, MELD)(r=−0.439,P<0.001)、MELD联合血清钠评分(r=−0.481,P<0.001)和慢性肝衰竭联盟-慢加急性肝衰竭预后评分(Chronic Liver Failure Consortium ACLF, CLIF-C ACLF)(r=−0.340,P<0.001)呈负相关。受试者工作特性(receiver operating characteristic, ROC)曲线分析示基线值,第一次、第二次、第三次使用人工肝治疗后的eGFR-CysC值判断患者28 d死亡与否的曲线下面积分别为0.639、0.697、0.716、0.749(P<0.001),eGFR-CysC最佳临界值分别为70.620、67.525、61.725、64.685 mL/(min·1.73 m2)。
      结论  eGFR-CysC水平能辅助评价人工肝治疗HBV-ACLF患者短期死亡率,动态监测的临床应用价值更高。

     

    Abstract:
      Objective  To evaluate the predictive value of using cystatin c-based estimated glomerular filtration rate (eGFR-CysC) in assessing the prognosis of hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF) patients treated with artificial liver support system (ALSS).
      Methods  A total of 364 HBV-ACLF inpatients treated with ALSS at our hospital were enrolled retrospectively in the study. The patients were divided into the survival group (n=269) and non-survival group (n=95) according to mortality within 28 d, and their clinical information and laboratory data were analyzed for assessing short-term prognostic values.
      Results  Multivariate Cox regression analysis identified eGFR-CysC as one of the independent risk factors associated with mortality within 28 days in HBV-ACLF patients (the hazard ratio=0.987; 95% confidence interval, 0.979-0.996, P=0.003). In addition, baseline eGFR-CysC was negatively correlated with the model for end-stage liver disease (MELD) score (r=−0.439, P<0.001), MELD plus sodium (MELD-Na) score (r=−0.481, P<0.001) and Chronic Liver Failure Consortium ACLF (CLIF-C ACLF) score (r=−0.340, P<0.001). Receiver operating characteristic (ROC) curve analysis showed area under the curve (AUC) of eGFR-CysC were 0.639, 0.697, 0.716, 0.749 and the best cut-off value were 70.620, 67.525, 61.725, 64.685 mL/(min·1.73 m2), respectively, for baseline value and the first, second, and third treatment with ALSS.
      Conclusion  eGFR-CysC could be used to assist clinical assessment of short-term mortality in HBV-ACLF patients treated with ALSS, and has better clinical application value for dynamic monitoring.

     

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