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[Model for end-stage liver disease combined with arterial blood lactate to assess the prognosis of hepatitis B virus-associated acute-on-chronic liver failure: a retrospective analysis of 97 cases].
Zhonghua Gan Zang Bing Za Zhi. 2019 Apr 20; 27(4):256-260.ZG

Abstract

Objective:

To explore the prognostic value of model for end-stage liver disease (MELD) combined with arterial blood lactate (Lac) in admitted patients with hepatitis B virus-associated acute- on-chronic liver failure (HBV-ACLF).

Methods:

Clinical data of 97 cases with hepatitis B virus-associated acute- on-chronic liver failure (HBV-ACLF) admitted to the First Affiliated Hospital of Suzhou University between March 2016 and March 2018 was retrospectively analyzed. Age, gender, complications, MELD score, lactic acid (Lac), total bilirubin (TBil), creatinine (Cr), serum albumin (Alb), high-sensitivity C-reactive protein (CRP), white blood cell count (WBC), platelet count (PLT), hematocrit (Hct), quantification of HBV DNA and HBsAg, and organ support treatment (artificial liver support system, renal replacement therapy and mechanical ventilation) were documented after admission. The primary endpoint of treatment was death due to ineffective medical treatment during hospitalization, abandonment of medical treatment due to deterioration of the health condition, and switch to liver transplantation for patients with poor medical treatment. The risk factors for primary endpoint of treatment were analyzed by binary logistic regression. Hosmer-Lemeshow test was used to evaluate the goodness of fit for the scoring system, and the ROC to predict the prognosis of MELD-Lac.

Results:

Ninety-seven cases with HBV-ACLF were included, 56 cases had good prognosis, and 41 cases had bad prognosis (including two cases with poor medical treatment and liver transplantation). The overall improvement rate was 57.7%. MELD score and Lac value in treated group was significantly lower than non-treated group. Bivariable and multivariable logistic regression analysis showed that the MELD score [odds ratio (OR = 1.806)], and Lac score [odds ratio (OR = 1.820)] was the risk factor for hospitalization and mortality in patients with liver failure (P < 0.05). The area under the ROC curve (AUC) and the 95% confidence interval (95% CI) of prognostic patients with MELD-Lac were significantly better than Lac and MELD scores [0.923 (0.84 to 1.00) vs. 0.804 (0.067 to 0.942) and 0.864 (0.75). 0.977)], P < 0.05. When the MELD-Lac Youden index was set at 0.746, the optimal threshold was 18.36, and the sensitivity and specificity were 91.3% and 83.3%, respectively.

Conclusion:

MELD-Lac score has a high prognostic value in HBV-ACLF patients.

Authors+Show Affiliations

Department of Infectious Diseases and Liver Diseases ICU, The First Affiliated Hospital of Soochow University, Suzhou 215006, China.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

chi

PubMed ID

31082335

Citation

Yao, Y H., et al. "[Model for End-stage Liver Disease Combined With Arterial Blood Lactate to Assess the Prognosis of Hepatitis B Virus-associated Acute-on-chronic Liver Failure: a Retrospective Analysis of 97 Cases]." Zhonghua Gan Zang Bing Za Zhi = Zhonghua Ganzangbing Zazhi = Chinese Journal of Hepatology, vol. 27, no. 4, 2019, pp. 256-260.
Yao YH, Zhao WF, Gan JH. [Model for end-stage liver disease combined with arterial blood lactate to assess the prognosis of hepatitis B virus-associated acute-on-chronic liver failure: a retrospective analysis of 97 cases]. Zhonghua Gan Zang Bing Za Zhi. 2019;27(4):256-260.
Yao, Y. H., Zhao, W. F., & Gan, J. H. (2019). [Model for end-stage liver disease combined with arterial blood lactate to assess the prognosis of hepatitis B virus-associated acute-on-chronic liver failure: a retrospective analysis of 97 cases]. Zhonghua Gan Zang Bing Za Zhi = Zhonghua Ganzangbing Zazhi = Chinese Journal of Hepatology, 27(4), 256-260. https://doi.org/10.3760/cma.j.issn.1007-3418.2019.04.004
Yao YH, Zhao WF, Gan JH. [Model for End-stage Liver Disease Combined With Arterial Blood Lactate to Assess the Prognosis of Hepatitis B Virus-associated Acute-on-chronic Liver Failure: a Retrospective Analysis of 97 Cases]. Zhonghua Gan Zang Bing Za Zhi. 2019 Apr 20;27(4):256-260. PubMed PMID: 31082335.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Model for end-stage liver disease combined with arterial blood lactate to assess the prognosis of hepatitis B virus-associated acute-on-chronic liver failure: a retrospective analysis of 97 cases]. AU - Yao,Y H, AU - Zhao,W F, AU - Gan,J H, PY - 2019/5/15/entrez PY - 2019/5/15/pubmed PY - 2019/6/5/medline KW - Acute-on-chronic liver failure KW - Hepatitis B virus KW - Lactate KW - Model for end-stage liver KW - Prognosis disease SP - 256 EP - 260 JF - Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology JO - Zhonghua Gan Zang Bing Za Zhi VL - 27 IS - 4 N2 - Objective: To explore the prognostic value of model for end-stage liver disease (MELD) combined with arterial blood lactate (Lac) in admitted patients with hepatitis B virus-associated acute- on-chronic liver failure (HBV-ACLF). Methods: Clinical data of 97 cases with hepatitis B virus-associated acute- on-chronic liver failure (HBV-ACLF) admitted to the First Affiliated Hospital of Suzhou University between March 2016 and March 2018 was retrospectively analyzed. Age, gender, complications, MELD score, lactic acid (Lac), total bilirubin (TBil), creatinine (Cr), serum albumin (Alb), high-sensitivity C-reactive protein (CRP), white blood cell count (WBC), platelet count (PLT), hematocrit (Hct), quantification of HBV DNA and HBsAg, and organ support treatment (artificial liver support system, renal replacement therapy and mechanical ventilation) were documented after admission. The primary endpoint of treatment was death due to ineffective medical treatment during hospitalization, abandonment of medical treatment due to deterioration of the health condition, and switch to liver transplantation for patients with poor medical treatment. The risk factors for primary endpoint of treatment were analyzed by binary logistic regression. Hosmer-Lemeshow test was used to evaluate the goodness of fit for the scoring system, and the ROC to predict the prognosis of MELD-Lac. Results: Ninety-seven cases with HBV-ACLF were included, 56 cases had good prognosis, and 41 cases had bad prognosis (including two cases with poor medical treatment and liver transplantation). The overall improvement rate was 57.7%. MELD score and Lac value in treated group was significantly lower than non-treated group. Bivariable and multivariable logistic regression analysis showed that the MELD score [odds ratio (OR = 1.806)], and Lac score [odds ratio (OR = 1.820)] was the risk factor for hospitalization and mortality in patients with liver failure (P < 0.05). The area under the ROC curve (AUC) and the 95% confidence interval (95% CI) of prognostic patients with MELD-Lac were significantly better than Lac and MELD scores [0.923 (0.84 to 1.00) vs. 0.804 (0.067 to 0.942) and 0.864 (0.75). 0.977)], P < 0.05. When the MELD-Lac Youden index was set at 0.746, the optimal threshold was 18.36, and the sensitivity and specificity were 91.3% and 83.3%, respectively. Conclusion: MELD-Lac score has a high prognostic value in HBV-ACLF patients. SN - 1007-3418 UR - https://www.unboundmedicine.com/medline/citation/31082335/[Model_for_end_stage_liver_disease_combined_with_arterial_blood_lactate_to_assess_the_prognosis_of_hepatitis_B_virus_associated_acute_on_chronic_liver_failure:_a_retrospective_analysis_of_97_cases]_ L2 - http://journal.yiigle.com/LinkIn.do?linkin_type=pubmed&amp;issn=1007-3418&amp;year=2019&amp;vol=27&amp;issue=4&amp;fpage=256 DB - PRIME DP - Unbound Medicine ER -