The predictive values of four scoring systems in short-term prognosis of patients with hepatitis B-associated acute-on-chronic liver failure

• Main Authors: LIU Huan, SONG Liwen, CAO Wukui
• Format: Article
• Language: zho
• Published: Editorial Department of Journal of Clinical Hepatology 2015-09-01
• Series: Linchuang Gandanbing Zazhi
• Online Access: http://www.lcgdbzz.org/qk_content.asp?id=6747

ObjectiveTo investigate the predictive values of four scoring systems, the Model for End-Stage Liver Disease (MELD), the MELD with incorporation of serum sodium (MELD-Na), the integrated MELD (iMELD), and the MELD to serum sodium ratio (MESO), in the short-term prognosis of patients with hepatitis B-associated acute-on-chronic liver failure (ACLF) after artificial liver support therapy. MethodsA total of 221 patients with hepatitis B-associated ACLF who were hospitalized from October 2007 to February 2013 were enrolled as subjects and divided into survival group (n=139) and death group (n=82). The levels of total bilirubin (TBil), serum creatinine (Cr), international normalized ratio (INR), serum sodium (Na+), and the scores of MELD, MELD-Na, iMELD, and MESO were determined and compared between the two groups. Comparison of continuous data between two groups was made by the Mann-Whitney U test or t test; comparison between multiple groups was made by the Kruskal-Wallis H test; comparison of categorical data was made by χ2 test; comparison of area under the receiver operating characteristic curve was made by normal Z test. ResultsThe age, TBil level, INR, and the scores of MELD, MELD-Na, iMELD, and MESO were significantly higher in the death group than in the survival group, while the serum level of Na+ was significantly lower in the death group than in the survival group (P＜0.001). Patients with end-stage liver failure had significantly higher scores than those with early-stage or intermediate-stage liver failure (P＜0.001), while patients with intermediate-stage liver failure had significantly higher scores than those with early-stage liver failure (P＜0.001). The mortality rate increased with increasing scores of MELD, MELD-Na, iMELD, and MESO. The optimal cut-off scores of MELD, MELD-Na, iMELD, and MESO were 37.989, 41.291, 55.406, and 2.693, respectively. There were no significant differences between any two scoring systems (P＞0.05). ConclusionAll four scoring systems can well predict the short-term clinical prognosis in patients with hepatitis B-associated ACLF after artificial liver support therapy combined with comprehensive medical treatment. The iMELD scoring system is slightly superior to the other three scoring systems. However, the application of these scoring systems still needs to be closely associated with actual clinical situations.