开发并验证用于预测急性-慢性肝衰竭患者生存结果的新预后模型

IF 3.1 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Journal of Clinical and Translational Hepatology Pub Date : 2024-10-28 Epub Date: 2024-09-30 DOI:10.14218/JCTH.2024.00316
Wende Li, Wanshu Liu, Yihui Rong, Dongze Li, Bing Zhu, Shaobo Yang, Shidong Sun, Shaoli You, Yu Chen, Jun Li
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引用次数: 0

摘要

背景和目的:早期确定急性-慢性肝衰竭(ACLF)患者的预后对于优化治疗方案和肝脏分配至关重要。本研究旨在确定与 ACLF 相关的风险因素,并开发可准确预测患者预后的新预后模型:我们回顾性地选择了2010年1月至2018年6月期间诊断为ACLF的1952名住院患者。该队列用于开发新的预后评分,随后在外部团体中进行了验证:该研究纳入了 1386 名 ACLF 患者,通过多变量分析确定了 28 天死亡率的六个独立预测因子(所有因子的 p 均小于 0.05)。基于多变量回归模型的新评分对 28 天和 90 天死亡率的预测准确性都很高,ROC 曲线下的面积分别为 0.863 和 0.853(均 p < 0.05)。该评分可用于对 ACLF 患者的死亡风险进行分层,显示出按临界值分类的患者生存率存在显著差异(log-rank (Mantel-Cox) χ2 = 487.574 和 606.441,p = 0.000)。此外,新模型在两个外部队列中表现出良好的稳健性:本研究提出了一个完善的预后模型--终末期肝病模型--并发症评分,它能准确预测 ACLF 患者的短期死亡率。该模型为改善 ACLF 患者的临床决策和短期预后评估提供了新的视角和工具。
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Development and Validation of a New Prognostic Model for Predicting Survival Outcomes in Patients with Acute-on-chronic Liver Failure.

Background and aims: Early determination of prognosis in patients with acute-on-chronic liver failure (ACLF) is crucial for optimizing treatment options and liver allocation. This study aimed to identify risk factors associated with ACLF and to develop new prognostic models that accurately predict patient outcomes.

Methods: We retrospectively selected 1,952 hospitalized patients diagnosed with ACLF between January 2010 and June 2018. This cohort was used to develop new prognostic scores, which were subsequently validated in external groups.

Results: The study included 1,386 ACLF patients and identified six independent predictors of 28-day mortality through multivariate analysis (all p < 0.05). The new score, based on a multivariate regression model, demonstrated superior predictive accuracy for both 28-day and 90-day mortalities, with Areas under the ROC curves of 0.863 and 0.853, respectively (all p < 0.05). This score can be used to stratify the risk of mortality among ACLF patients with ACLF, showing a significant difference in survival between patients categorized by the cut-off value (log-rank (Mantel-Cox) χ2 = 487.574 and 606.441, p = 0.000). Additionally, the new model exhibited good robustness in two external cohorts.

Conclusions: This study presents a refined prognostic model, the Model for end-stage liver disease-complication score, which accurately predicts short-term mortality in ACLF patients. This model offers a new perspective and tool for improved clinical decision-making and short-term prognostic assessment in ACLF patients.

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来源期刊
Journal of Clinical and Translational Hepatology
Journal of Clinical and Translational Hepatology GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
6.40
自引率
2.80%
发文量
496
期刊最新文献
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