急性肝衰竭短期预后模型研究.docVIP

DOI：10.16016/j.1000-5404.201501129 急性肝衰竭短期预后模型研究 谢桂娟，张辉艳，陈晴，李锐锋，赵博，张绪清（400038 重庆，第三军医大学西南医院全军感染病研究所，感染病研究重庆市重点实验室）odel for acute liver failure, MALF）为：P= 1/[1+ exp(-y)], y= 4.448 + 0.074×TB + 0.938×INR－0.064×Na+ + 1.031×腹水 + 1.677×感染。模型敏感度为98.03%，特异度为97.26%。MALF曲线下面积（area under the curve of ROC,AUC）为0.952（95%CI 0.907~0.997)，高于MELD 0.783（95%CI 0.720~0.845）、MELD-Na 0.825（95%CI 0.762~0.887）、IMELD 0.793（95%CI 0.726~0.860）、UKELD 0.841（95%CI 0.781~0.901），均具有显著统计学差异（P＜0.001）。结论 构建模型MALF具有较高的敏感度和特异性，对ALF患者短期死亡危险性评估有较好的临床应用价值，预测能力优于MELD、MELD-Na、IMELD和UKELD评分。 [关键词急性肝衰竭；Logistic回归；预后 A new prognostic model to predict short-term prognosis of acute liver failure Xie Guijuan1 , Zhang Huiyan2, Chen Qing3, Li Ruifeng4 , Zhao Bo5, Zhang Xuqing（Institute of Infectious Diseases, Chongqing Key Laboratory for Infectious Diseases Research, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China .） Abstract] Objective To establish a new prognostic model of 3-month mortality in patients with acute liver failure (ALF) and compare the values of new model, MELD, MELD-Na, IMELD and UKELD in predicting the prognosis of ALF. Methods In a retrospective case-control study, 234 patients with ALF were retrospectively recruited in the study and divided into two groups according to the prognosis. Their laboratory parameters and complication were compared. SPSS 19.0 software was used for statistical analysis. Multivariate logistic regression analysis was used to establish the model. The predictive accuracy of models was compared using the area under the receiver operating characteristic curve method. Results The 3-month mortality in ALF was 76.50%.The factors predicting prognosis were total bilirubin (TB)(OR 1.077, 95%CI 1.028~1.130, P=0.002), international normalized ratio (INR)(OR 2.555,95%CI 1.561~4.182, P=0.000), serum Na+(OR 0.938, 95%CI 0.883~0.996, P=0.037), ascites(OR 2.804,95%CI 1.140~6.892, P=0.025)and infections(OR 5.348,95%CI 2.268~12.610, P=0.000) reached the cri