Short-term prognostic value of age-bilirubin-international normalized ratio-creatinine score in patients with hepatitis B virus-related acute-on-chronic liver failure

doi:10.3877/cma.j.issn.1674-1358.2022.02.005

Abstract

Abstract:

Objective

To investigate the prognostic value of age-bilirubin-international normalized ratio-creatinine (ABIC) score in the short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF).

Methods

Total of 191 patients with HBV-ACLF hospitalized in the Department of Infectious Diseases, Liuhe People’s Hospital, Yangzhou University Medical College from January 2017 to December 2019 were collected, retrospectively, and were divided into survival group (129 cases) and death group (62 cases) according to their 90-day prognosis. Hemoglobin (Hb), white blood cells (WBC), platelets, international normalized ratio (INR), alanine aminotransferase (ALT), albumin, total bilirubin, gamma glutamyltransferase (γ-GT), serum creatinine and urea nitrogen of all patients were collected within 24 hours after admission. The model for end-stage liver disease (MELD), Child-Pugh (CP), ABIC, albumin-bilirubin (ALBI) and CLIF consortium organ failure (CLIF-C OF) were scored, respectively. The prognostic factors of HBV-ACLF patients were analyzed by Cox regression model, the value of different scoring models for 90-day prognosis were analyzed by receiver operating characteristic curve (ROC), and area under the ROC curves (AUCs) were compared by Medcalc software. The survival analysis was carried out by K-M method.

Results

ABIC score of patients in death group was significantly higher than that of survival group [10.6 (8.3, 12.6) vs. 8.5 (6.4, 10.4): Z =-5.385, P < 0.001]. Age (χ² = 6.337, P = 0.012), CP (χ² = 6.131, P = 0.013), ABIC (χ² = 14.531, P < 0.001) and CLIF-C OF (χ² = 7.369, P = 0.007) were all independent risk factors for 90-day prognosis of patients with HBV-ACLF, with significant differences. AUC of ABIC for 90-day mortality was significantly higher than that of MELD and ALBI [0.741 (0.673-0.801) vs. 0.658 (0.586-0.725): Z = 3.869, P = 0.000; 0.741 (0.673-0.801) vs. 0.647 (0.575-0.715): Z = 9.453, P < 0.001], and there was no significant difference compared with AUCs of CP and CLIF-C OF [0.741 (0.673-0.801) vs. 0.727 (0.658-0.789): Z = 1.078, P = 0.281; 0.741 (0.673-0.801) vs. 0.716 (0.646-0.778): Z = 1.441, P = 0.150]. Further investigation on the prognosis of HBV-ACLF patients with different ABIC levels showed that the 90 d survival rate was 47.6% of patients with high ABIC (≥ 9.9), which was significantly lower than that of cases with low ABIC (< 9.9) (77.3%), with significant difference (χ² = 19.515, P < 0.001).

Conclusions

ABIC score could be used as an effective predictor of short-term prognosis in patients with HBV-ACLF, ABIC score > 9.9 may predict high short-term mortality risk in patients with HBV-ACLF.

Key words: Hepatitis B, Liver failure, Acute-on-chronic, age-bilirubin-international normalized ratio-creatinine score, Prognosis

Xiang Gao, Chengjun Zhao, Shihong Hu. Short-term prognostic value of age-bilirubin-international normalized ratio-creatinine score in patients with hepatitis B virus-related acute-on-chronic liver failure[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2022, 16(02): 108-114.

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References 25

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项目	合计（191例）	生存组（129例）	死亡组（62例）	统计量	P值
年龄（ ± s，岁）	45.2 ± 12.6	43.3 ± 12.9	49.4 ± 11.0	t =-3.206	0.002
男性[例（%）]	156（81.7）	104（80.6）	52（83.9）	χ² = 0.296^a	0.587
肝硬化[例（%）]	47（24.6）	28（21.7）	19（30.6）	χ² = 1.804^a	0.179
血红蛋白（ ± s，g/L）	121.9 ± 21.3	124.9 ± 20.2	115.7 ± 22.2	t = 2.853	0.005
白细胞（ ± s，× 10⁹/L）	8.5 ± 3.9	8.5 ± 3.8	8.4 ± 4.1	t = 0.164	0.870
血小板[M（P25，P75），× 10⁹/L]	106（74，139）	110（77，143）	101（67，127）	Z =-2.076	0.038
INR [M（P25，P75）]	2.2（1.8，2.6）	2.0（1.7，2.4）	2.5（2.0，3.4）	Z =-4.206	< 0.001
ALT [M（P25，P75），U/L]	183（87，409）	204（88，481）	162（78，304）	Z =-1.823	0.068
白蛋白[M（P25，P75），g/L]	32（29，36）	32（30，36）	31（29，34）	Z =-2.096	0.036
总胆红素[M（P25，P75），μmol/L]	401（321，501）	371（303，442）	448（379，541）	Z =-3.359	0.001
γ-GT [M（P25，P75），U/L]	79（59，115）	83（61，124）	73（47，108）	Z =-1.360	0.174
血肌酐[M（P25，P75），μmol/L]	79（70，97）	76（68，89）	94（74，139）	Z =-4.801	< 0.001
尿素氮[M（P25，P75），mmol/L]	4.5（3.4，6.3）	4.1（3.2，5.3）	6.1（3.8，9.9）	Z =-4.393	< 0.001
MELD [M（P25，P75）]	28.2（25.5，31.5）	27.2（25.3，28.8）	31.1（27.2，34.7）	Z =-3.538	< 0.001
CP [M（P25，P75）]	12（10，13）	11（10，12）	13（12，14）	Z =-5.123	< 0.001
ABIC [M（P25，P75）]	9.6（7.1，11.0）	8.5（6.4，10.4）	10.6（8.3，12.6）	Z =-5.385	< 0.001
ALBI [M（P25，P75）]	-1.0（-1.2，-0.8）	-1.1（-1.3，-0.9）	-0.9（-1.1，-0.7）	Z =-3.290	0.001
CLIF-C OF [M（P25，P75）]	10（8，11）	9（8，10）	11（9，12）	Z =-4.871	< 0.001

项目	合计（191例）	生存组（129例）	死亡组（62例）	统计量	P值
年龄（ ± s，岁）	45.2 ± 12.6	43.3 ± 12.9	49.4 ± 11.0	t =-3.206	0.002
男性[例（%）]	156（81.7）	104（80.6）	52（83.9）	χ² = 0.296^a	0.587
肝硬化[例（%）]	47（24.6）	28（21.7）	19（30.6）	χ² = 1.804^a	0.179
血红蛋白（ ± s，g/L）	121.9 ± 21.3	124.9 ± 20.2	115.7 ± 22.2	t = 2.853	0.005
白细胞（ ± s，× 10⁹/L）	8.5 ± 3.9	8.5 ± 3.8	8.4 ± 4.1	t = 0.164	0.870
血小板[M（P25，P75），× 10⁹/L]	106（74，139）	110（77，143）	101（67，127）	Z =-2.076	0.038
INR [M（P25，P75）]	2.2（1.8，2.6）	2.0（1.7，2.4）	2.5（2.0，3.4）	Z =-4.206	< 0.001
ALT [M（P25，P75），U/L]	183（87，409）	204（88，481）	162（78，304）	Z =-1.823	0.068
白蛋白[M（P25，P75），g/L]	32（29，36）	32（30，36）	31（29，34）	Z =-2.096	0.036
总胆红素[M（P25，P75），μmol/L]	401（321，501）	371（303，442）	448（379，541）	Z =-3.359	0.001
γ-GT [M（P25，P75），U/L]	79（59，115）	83（61，124）	73（47，108）	Z =-1.360	0.174
血肌酐[M（P25，P75），μmol/L]	79（70，97）	76（68，89）	94（74，139）	Z =-4.801	< 0.001
尿素氮[M（P25，P75），mmol/L]	4.5（3.4，6.3）	4.1（3.2，5.3）	6.1（3.8，9.9）	Z =-4.393	< 0.001
MELD [M（P25，P75）]	28.2（25.5，31.5）	27.2（25.3，28.8）	31.1（27.2，34.7）	Z =-3.538	< 0.001
CP [M（P25，P75）]	12（10，13）	11（10，12）	13（12，14）	Z =-5.123	< 0.001
ABIC [M（P25，P75）]	9.6（7.1，11.0）	8.5（6.4，10.4）	10.6（8.3，12.6）	Z =-5.385	< 0.001
ALBI [M（P25，P75）]	-1.0（-1.2，-0.8）	-1.1（-1.3，-0.9）	-0.9（-1.1，-0.7）	Z =-3.290	0.001
CLIF-C OF [M（P25，P75）]	10（8，11）	9（8，10）	11（9，12）	Z =-4.871	< 0.001

项目	临界值	AUC	95%CI	敏感度（%）	特异度（%）	P值
MELD	29.7	0.658	0.586~0.725	66.13	78.29	< 0.001
CP	11	0.727	0.658~0.789	77.42	58.14	< 0.001
ABIC	9.9	0.741	0.673~0.801	62.90	73.64	< 0.001
ALBI	-1.01	0.647	0.575~0.715	64.52	60.47	< 0.001
CLIF-C OF	10	0.716	0.646~0.778	56.45	79.84	< 0.001

项目	临界值	AUC	95%CI	敏感度（%）	特异度（%）	P值
MELD	29.7	0.658	0.586~0.725	66.13	78.29	< 0.001
CP	11	0.727	0.658~0.789	77.42	58.14	< 0.001
ABIC	9.9	0.741	0.673~0.801	62.90	73.64	< 0.001
ALBI	-1.01	0.647	0.575~0.715	64.52	60.47	< 0.001
CLIF-C OF	10	0.716	0.646~0.778	56.45	79.84	< 0.001

变量	赋值
年龄	连续纳入
血红蛋白	< 121.9 g/L = 0，≥ 121.9 g/L = 1
血小板	< 106 × 10⁹/L = 0，≥ 106 × 10⁹/L = 1
INR	< 2.2 = 0，≥ 2.2 = 1
ALT	< 183 U/L = 0，≥ 183 U/L = 1
白蛋白	< 32 g/L = 0，≥ 32 g/L = 1
总胆红素	< 401 μmol/L = 0，≥ 401 μmol/L = 1
血肌酐	< 79 μmol/L = 0，≥ 79 μmol/L = 1
尿素氮	< 4.5 mmol/L = 0，≥ 4.5 mmol/L = 1
MELD	< 29.7 = 0，≥ 29.7 = 1
CP	< 11 = 0，≥ 11 = 1
ABIC	< 9.9 = 0，≥ 9.9 = 1
ALBI	<-1.01 = 0，≥-1.01 = 1
CLIF-C OF	< 10 = 0，≥ 10 = 1

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