前螺旋体蛋白和降钙素原作为酒精性肝硬化和急性或慢性肝功能衰竭患者死亡预后因素的价值。

IF 0.8 Q3 MEDICINE, GENERAL & INTERNAL Archive of clinical cases Pub Date : 2024-07-16 eCollection Date: 2024-01-01 DOI:10.22551/2024.43.1102.10290
Răzvan Igna, Cristina Muzica, Sebastian Zenovia, Horia Minea, Irina Girleanu, Laura Huiban, Anca Trifan
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引用次数: 0

摘要

背景:急性慢性肝功能衰竭(ACLF)的典型特征是肝硬化患者的肝功能衰竭进展迅速,其诱因通常是细菌感染(BI)。考虑到肝硬化中炎症生物标志物的准确性较低,前螺旋体蛋白和降钙素原对 BI 有良好的诊断效果。了解影响患者预后的关键预后因素可极大地影响临床决策并改善 ACLF 患者的护理,从而降低死亡率。目的:评估与酒精相关性肝硬化和 ACLF 患者 30 天死亡率相关的预后因素。方法:对 227 例酒精相关性肝硬化和 ACLF 患者进行回顾性研究:该回顾性研究对 227 例确诊为 ACLF 和酒精相关性肝硬化的患者进行了研究,分析了前螺旋体素和降钙素原血清水平的预后作用。研究结果根据 ACLF 分级进行的生存分析表明,超过 80% 的 ACLF 1 级患者在 30 天后存活,平均估计死亡时间为 29 ±0.44 天(95 % CI:28.17-29.92)。92),而 ACLF 分级 2(24.9±1.064 天;95 % CI:22.82-26.99)和 ACLF 分级 3(21.05±1.17 天;95 % CI:18.75-23.34),整个队列的平均总生存期为 25.69±0.52 天(95 % CI:24.65-26.73)。前血蛋白(OR:4.008,CI 95:3.130-6.456,P=0.001)和降钙素原(OR:3.666,CI 95:2.312-5.813,P=0.001)是与 30 天死亡率相关的最重要因素。在 ACLF 2 级患者中,在 1050 pg/mL 临界值(灵敏度 72%,特异度 69%)时,前血蛋白比降钙素原(AUC=0.727 95% CI 0.594-0.860,p=0.001)能更好地预测死亡率:前交叉韧带纤维炎与高死亡率有关,死亡风险随前交叉韧带纤维炎的等级而增加。前螺旋体素和降钙素原血清水平是影响 30 天死亡率的良好预后因素,应在临床实践中用于对 ACLF 患者进行风险分层并提供早期有效治疗。
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The value of presepsin and procalcitonin as prognostic factors for mortality in patients with alcoholic liver cirrhosis and acute on chronic liver failure.

Background: Acute on chronic liver failure (ACLF) is typically characterized by a rapid progression of liver failure in patients with liver cirrhosis and it is triggered by a precipitant factor, usually a bacterial infection (BI). Considering the low accuracy of the inflammation biomarkers in liver cirrhosis, presepsin and procalcitonin have demonstrated a good diagnostic performance for BI. Understanding the key prognostic factors that influence patient outcomes can significantly impact clinical decision-making and improve patient care in ACLF which can lead to lower mortality rates. Aim: To evaluate the prognostic factors associated with 30-day mortality in patients with alcohol-related liver cirrhosis and ACLF. Methods: This retrospective study on 227 patients diagnosed with ACLF and alcohol-related liver cirrhosis analyzed the prognostic role of presepsin and procalcitonin serum levels. Results: The survival analysis according to the grade of ACLF showed that more than 80% of patients with ACLF grade 1 survived after 30 days, with a mean estimated time of death of 29 ±0.44 days (95 % CI: 28.17-29.92) compared to ACLF grade 2 (24.9±1.064 days; 95 % CI: 22.82-26.99) and ACLF grade 3 (21.05±1.17 days; 95 % CI: 18.75-23.34), with a mean overall survival on entire cohort of 25.69±0.52 days (95 % CI: 24.65-26.73). Presepsin (OR: 4.008, CI 95:3.130-6.456, p=0.001) and procalcitonin (OR: 3.666, CI 95:2.312-5.813, p=0.001) were the most significant factors associated with 30-day mortality. In ACLF grade 2, presepsin provides a better prediction of mortality at the cutoff value of 1050 pg/mL (Sensitivity 72%, Specificity 69%) than procalcitonin (AUC=0.727 95% CI 0.594-0.860, p<0.002) whereas in ACLF grade 3, a cutoff of 1450 pg/mL (Sensitivity 89%, Specificity 91%) presepsin had a more significant accuracy of mortality prediction (AUC=0.93 95% CI 0.81-0.99, p<0.001) than procalcitonin (AUC=0.731 95% CI 0.655-0.807, p<0.001). Conclusion: ACLF is associated with a high mortality rate and the risk of death increases with the grade of ACLF. Presepsin and procalcitonin serum levels are good prognostic factors for 30-day mortality and should be used in clinical practice to stratify the risk and provide and early and efficient treatment in patients with ACLF.

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