Objective: To evaluate the predictive value of using cystatin c-based estimated glomerular filtration rate (eGFR-CysC) in assessing the prognosis of hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF) patients treated with artificial liver support system (ALSS).
Methods: A total of 364 HBV-ACLF inpatients treated with ALSS at our hospital were enrolled retrospectively in the study. The patients were divided into the survival group ( n=269) and non-survival group ( n=95) according to mortality within 28 d, and their clinical information and laboratory data were analyzed for assessing short-term prognostic values.
Results: Multivariate Cox regression analysis identified eGFR-CysC as one of the independent risk factors associated with mortality within 28 days in HBV-ACLF patients (the hazard ratio=0.987; 95% confidence interval, 0.979-0.996, P=0.003). In addition, baseline eGFR-CysC was negatively correlated with the model for end-stage liver disease (MELD) score ( r=-0.439, P<0.001), MELD plus sodium (MELD-Na) score ( r=-0.481, P<0.001) and Chronic Liver Failure Consortium ACLF (CLIF-C ACLF) score ( r=-0.340, P<0.001). Receiver operating characteristic (ROC) curve analysis showed area under the curve ( AUC) of eGFR-CysC were 0.639, 0.697, 0.716, 0.749 and the best cut-off value were 70.620, 67.525, 61.725, 64.685 mL/(min·1.73 m 2), respectively, for baseline value and the first, second, and third treatment with ALSS.
Conclusion: eGFR-CysC could be used to assist clinical assessment of short-term mortality in HBV-ACLF patients treated with ALSS, and has better clinical application value for dynamic monitoring.
目的: 探讨胱抑素C估算肾小球滤过率（cystatin C-based estimated glomerular filtration rate, eGFR-CysC）对人工肝治疗的乙型肝炎病毒相关性慢加急性肝功能衰竭（hepatitis B virus-related acute-on-chronic liver failure, HBV-ACLF）预后的预测价值。
方法: 回顾性收集我院364例人工肝治疗的HBV-ACLF住院患者，根据28 d死亡率将患者分为存活组269例和死亡组95例，分析临床资料和实验室数据对患者短期预后的价值。
结果: 多因素Cox回归分析显示，基线eGFR-CysC水平低是HBV-ACLF患者28 d死亡率的独立风险因素之一（风险比=0.987；95%置信区间：0.979～0.996，P=0.003）。基线eGFR-CysC水平与终末期肝病模型评分（the model for end-stage liver disease, MELD）（r=−0.439，P<0.001）、MELD联合血清钠评分（r=−0.481，P<0.001）和慢性肝衰竭联盟-慢加急性肝衰竭预后评分（Chronic Liver Failure Consortium ACLF, CLIF-C ACLF)（r=−0.340，P<0.001）呈负相关。受试者工作特性（receiver operating characteristic, ROC）曲线分析示基线值，第一次、第二次、第三次使用人工肝治疗后的eGFR-CysC值判断患者28 d死亡与否的曲线下面积分别为0.639、0.697、0.716、0.749（P<0.001），eGFR-CysC最佳临界值分别为70.620、67.525、61.725、64.685 mL/(min·1.73 m2)。
结论: eGFR-CysC水平能辅助评价人工肝治疗HBV-ACLF患者短期死亡率，动态监测的临床应用价值更高。
Keywords: 28-day mortality; Artificial liver support system; Cystatin C-based estimated glomerular filtration rate; Hepatitis B virus-related acute-on-chronic liver failure.
Copyright© by Editorial Board of Journal of Sichuan University (Medical Sciences).