血小板计数及相关评分模型对HBV相关慢加急性肝衰竭预后的预测价值

Abstract

目的 探究血小板(PLT)计数与HBV相关慢加急性肝衰竭(HBV-ACLF)预后的相关性，建立新的PLT相关评分模型并评估其在HBV-ACLF短期预后中的预测价值。 方法 选取2018年1月—2022年1月于西部战区总医院消化内科住院治疗的HBV-ACLF患者作为回顾性研究队列。收集所有患者入院24 h内的临床资料，根据随访180天后的生存情况将患者分为生存组和死亡组。符合正态分布的计量资料组间比较采用成组t检验；不符合正态分布的计量资料组间比较采用Mann-Whitney U检验；计数资料组间比较采用χ²检验。采用Pearson相关系数分析各指标之间相关性。采用Logistic回归模型进行预后影响因素分析。采用受试者工作曲线评估预后模型预测价值。通过Kaplan-Meier曲线分析患者生存情况。 结果 共纳入236例患者，180天生存率为75.85%(179/236)。死亡组年龄[(53.98±10.45)岁vs (47.44±12.46)岁，P=0.001]、INR[1.78(1.46~2.04) vs 1.47(1.23~1.68)，P＜0.001]、TBil[275.60(165.00~451.45) μmol/L vs 230.60(154.90~323.70) μmol/L，P=0.035]、MELD评分[21.47(18.14~24.76)分vs 18.67(15.70~21.62)分，P＜0.001]、ALBI评分[-1.06(-1.64~-0.86)分vs-1.32(-1.73~-1.01)分，P=0.034] 高于生存组，PLT水平[80.00(50.00~124.50)×10⁹/L vs 115.00(82.00~143.00)×10⁹/L，P=0.001]、PWR[13.40(9.54~20.70) vs 18.49(13.95~24.74)，P=0.001]低于生存组，差异均有统计学意义。Pearson相关性分析显示，PLT与肝硬化的发生及INR呈负相关(r值分别为-0.332、-0.194，P值分别为＜0.001、0.003)。多因素Logistic回归分析显示，年龄、PLT、INR为HBV-ACLF患者180天预后的独立影响因素(OR值分别为1.045、0.990、2.591，95%CI分别为1.015~1.076、0.983~0.998、1.363~4.925)。获得新的预测模型：AIP=0.006×年龄+0.187×INR-0.001×PLT。AIP评分模型对预测HBV-ACLF患者180天生存率曲线下面积(AUC)为0.718 (敏感度为81.1%，特异度为54.1%)，而PLT、PWR、LPACLF评分、MELD评分、ALBI评分的AUC分别为0.673、0.659、0.588、0.647、0.578。AIP评分模型的cut-off值为0.48。Kaplan-Meier生存分析发现，高AIP评分组的生存率明显低于低AIP评分组(P＜0.001)。 结论 PLT相关评分模型对HBV-ACLF预后的预测价值优于其他模型，高PLT水平HBV-ACLF患者的整体生存率更高。

Alternate abstract:

Objective To investigate the association between platelet count (PLT) and the prognosis of hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF), to establish a new PLT-related scoring model, and to assess its value in predicting the short-term prognosis of HBV-ACLF. Methods A retrospective cohort study was conducted among the patients with HBV-ACLF who were hospitalized and treated in Department of Gastroenterology, The General Hospital of Western Theater Command, from January 2018 to January 2022. Clinical data within 24 hours after admission were collected from all patients, and according to the survival after 180 days of follow-up, the patients were divided into survival group and death group. The independent-samples t test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups. The Pearson correlation coefficient was used to investigate the correlation between different indicators, and the logistic regression model was used to analyze the influencing factors for prognosis. The receiver operating characteristic (ROC) curve was used to assess the predictive value of the prognostic model, and the Kaplan-Meier curve analysis was used to investigate the survival condition of the high AIP group and the low AIP group. Results A total of 236 patients were enrolled, with a 180-day survival rate of 75.85% (179/236). Compared with the survival group, the death group had significantly higher age (53.98±10.45 vs 47.44±12.46, P=0.001), international normalized ratio (INR) [1.78 (1.46-2.04) vs 1.47 (1.23-1.68), P < 0.001], total bilirubin [275.60 (165.00-451.45) vs 230.60 (154.90-323.70), P=0.035], Model for End-Stage Liver Disease (MELD) score [21.47 (18.14-24.76) vs 18.67 (15.70-21.62), P < 0.001], and albumin-bilirubin (ALBI) score [-1.06 (-1.64~-0.86) vs-1.32 (-1.73~-1.01), P=0.034], as well as significantly lower PLT [80.00 (50.00~124.50) vs 115.00 (82.00~143.00), P=0.001] and platelet-to-white blood cell ratio (PWR) [13.40 (9.54~20.70) vs 18.49 (13.95~24.74), P=0.001]. The Pearson correlation analysis showed that PLT was negatively correlated with liver cirrhosis and INR (r=-0.332 and -0.194, P < 0.001 and P=0.003). The multivariate logistic regression analysis showed that age (odds ratio [OR]=1.045, 95% confidence interval [CI]: 1.015-1.076), PLT (OR=0.990, 95%CI: 0.983-0.998), and INR (OR=2.591, 95%CI: 1.363-4.925) were independent risk factors for the 180-day prognosis of HBV-ACLF patients. The new predictive model was established as follows: AIP=0.006×age+0.187×INR-0.001×PLT. The AIP scoring model had an area under the ROC curve (AUC) of 0.718 in predicting the 180-day prognosis of HBV-ACLF patients, with a sensitivity of 81.1% and a specificity of 54.1%, while PLT, PWR, LPACLF score, MELD score, and ALBI score had an AUC of 0.673, 0.659, 0.588, 0.647, and 0.578, respectively. The AIP scoring model had an optimal cut-off value of 0.48. The Kaplan-Meier survival analysis showed that the high AIP group had a significantly lower survival rate than the low AIP group (P < 0.001). Conclusion The PLT-related scoring model has a better value than other models in predicting the prognosis of HBV-ACLF, and HBV-ACLF patients with a relatively high PLT level tend to have a high overall survival rate.