A new prognostic model to predict short-term prognosis of acute liver failure: based on 234 cases

谢桂娟; 张辉艳; 陈晴; 李锐锋; 赵博; 张绪清

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A new prognostic model to predict short-term prognosis of acute liver failure: based on 234 cases

更新时间：2026-01-09

- A new prognostic model to predict short-term prognosis of acute liver failure: based on 234 cases
- Journal of Army Medical University Vol. 37, Issue 18, Pages: 1864-1869(2015)
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  CLC： R-332;R575.3
- Published：2015
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谢桂娟,张辉艳,陈晴,李锐锋,赵博,张绪清.急性肝衰竭短期预后模型研究[J].陆军军医大学学报(原第三军医大学学报),2015,37(18):1864-1869.

　Xie Guijuan,Zhang Huiyan,Chen Qing,Li Ruifeng,Zhao Bo,Zhang Xuqing.A new prognostic model to predict short-term prognosis of acute liver failure: based on 234 cases[J].J Amry Med Univ (J Third Mil Med Univ),2015,37(18):1864-1869.
谢桂娟,张辉艳,陈晴,李锐锋,赵博,张绪清.急性肝衰竭短期预后模型研究[J].陆军军医大学学报(原第三军医大学学报),2015,37(18):1864-1869. DOI：

　Xie Guijuan,Zhang Huiyan,Chen Qing,Li Ruifeng,Zhao Bo,Zhang Xuqing.A new prognostic model to predict short-term prognosis of acute liver failure: based on 234 cases[J].J Amry Med Univ (J Third Mil Med Univ),2015,37(18):1864-1869. DOI：

摘要

目的构建急性肝衰竭（acute liver failure

ALF）短期预后模型并与MELD、MELD-Na、IMELD和UKELD评分进行对比，分析其有效性。方法筛选234例ALF患者，采用回顾性病例对照研究，根据预后分为生存组与死亡组，比较两组间达到ALF诊断标准时的实验室相关指标及并发症发生情况。应用SPSS 19.0软件进行统计分析， Logistic多因素回归分析法对以上指标构建预测ALF患者短期死亡危险性的模型，通过受试者工作特征曲线法（ROC）检验模型预测有效性。结果 ALF 3个月死亡率为76.50%，筛选出与ALF预后相关变量分别是达到ALF诊断标准时的总胆红素（TB）（OR 1.077，95%CI 1.028~1.130， P=0.002），国际标准化比率（INR）（OR 2.555，95%CI 1.561~4.182，P=0.000），血钠（Na

）（OR 0.938，95%CI 0.883~0.996， P=0.037），腹水（OR 2.804，95%CI 1.140~6.892，P=0.025）和感染（OR 5.348，95%CI 2.268~12.610，P=0.000）。建立ALF短期预后模型（model 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），均具有统计学差异（P0.001）。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。

Abstract

Objective To establish a new prognostic model of 3-month mortality in patients with acute liver fa

ilure (ALF) and compare the values of our new model with the model for end-stage liver disease (MELD)

MELD with incorporation of sodium (MELD-Na)

integrated MELD (IMELD) and United Kingdom model for end-stage liver disease (UKELD) in predicting the prognosis of ALF. Methods In a retrospective case-control study

234 patients with ALF hospitalized in our institute from January 2000 to December 2012 were retrospectively recruited in the study

and divided into 2 groups according to their prognosis

that is

the survival and the dead. Their laboratory parameters and complications 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 (ROC) curve. 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) when the indexes reached the criterion of ALF on admission. Our short-term prognosis model for ALF (MALF) is: P=1/[1+exp(-y)

]

y= 4.448+0.074×TB+0.938×INR-0.064×Na

+1．031×Ascites+1.677×Infections. MALF had a sensitivity of 98.03% and a specificity of 97.26%. MALF had a higher value of AUC (0.952

95%CI=0.907~0.997)

when compared to 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)

and UKELD (0.841

95%CI=0.781~0.901)

and their differences were all statistically significant (P0.001). Conclusion Our established prognostic model of ALF has superior sensitivity and specificity. It is of good clinical value

and superior to the MELD

MELD-Na

IMELD and UKELD scores in prediction of short-term prognosis of ALF.

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