老年肝衰竭患者预后影响因素分析及其预后模型的构建

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摘要目的: 研究影响老年肝衰竭患者预后的危险因素，并建立新的预测模型。方法: 收集2012年1月至2020年7月在江苏大学附属镇江三院住院的201例老年肝衰竭患者，分为好转组（n=109）和恶化组（n=92），将两组基础临床资料和各项实验室检测指标行单因素分析和多因素Logistic回归分析，筛选出影响老年肝衰竭患者的独立危险因素；进一步进行多因素Logistic回归分析并构建预后预测模型，绘制受试者工作特征（ROC）曲线评价预测价值。结果：单因素分析显示两组白细胞、血氨、谷丙转氨酶、凝血酶原时间、总胆红素等检测指标和感染、肝性脑病、上消化道出血及肝肾综合征发病率差异有统计学意义（P<0.05）。多因素Logistic回归分析显示感染（OR=8.344，P<0.05）、凝血酶原时间（OR=1.185，P<0.01）、肝性脑病（OR=8.359，P<0.01）和总胆红素（OR=1.005，P<0.01）为预测老年肝衰竭患者预后的独立危险因素。创建新预测模型：Y=-6.082+0.005×总胆红素（μmol/L）+0.170×凝血酶原时间（s）+2.123×\[肝性脑病（无: 0, 有: 1）\] +2.122×\[感染（无: 0, 有: 1）\]。预测模型的ROC曲线下面积为0.923（95％CI：0.885~0.961，P<0.01）。结论：感染、总胆红素、肝性脑病和凝血酶原时间为预测老年肝衰竭患者预后的独立危险因素，所建立的新预测模型对老年肝衰竭患者预后具有较好的预测价值。

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	姚雅极
	邹圣强
	胡佳民
	吉芳
	赵群
	周建国
	庄涛
	张凯
	严孝馨
	江竹月
	陈丽
	刘津含

关键词 ：肝衰竭, 老年, 预后, 危险因素, 预测模型, 受试者工作特征曲线

Abstract：Objective: To explore the prognostic risk factors of the elderly liver failure patients and establish a new predictive model for prognosis. Methods: The clinical data of the 201 cases of elderly liver failure patients in the Affiliated Third Hospital of Jiangsu University from January 2012 to July 2020 were collected. The patients were divided into improved group （n=109） and deteriorated group （n=92）. The baseline clinical parameters and laboratory markers of the two groups were analyzed through univariate analysis and multivariate Logistic regression analysis to obtain independent risk factors for prognosis of the elderly liver failure patients. Logistic regression was further used to establish a predictive model of joint indicators, the receiver operator characteristic （ROC） curve was used to evaluate value of the predictive model. Results: The univariate analysis displayed that the infection, leukocyte, elevated alanine aminotransferase, upper gastrointestinal hemorrhage, blood ammonia, hepatorenal syndrome, total bilirubin, hepatic encephalopathy and pothrombin time were significantly different between the two groups （P<0.05）. Multivariate Logistic regression analysis showed that the infection （OR=8.344，P<0.05）, pothrombin time （OR=1.185，P<0.01）, total bilirubin （OR=1.005，P<0.01） and hepatic encephalopathy （OR=8.359，P<0.01） were the independent risk factors for the prognosis of elderly liver failure patients. Therefore, a new predictive model was established for prognosis: Y=-6.082+0.005×total bilirubin （μmol/L）+0.170×pothrombin time （s）+2.123×\[hepatic encephalopathy （no: 0, with: 1）\]+2.122×\[infection （no: 0, with: 1）\]. The area under the ROC curve of predictive model was 0.923（95％CI：0.885-0.961，P<0.001）. Conclusion: The infection, pothrombin time, total bilirubin and hepatic encephalopathy were the independent risk factors for the prognosis of elderly liver failure patients; and the predictive model of combined 4 indicators has good value in predicting for the elderly liver failure patients.

收稿日期: 2020-09-05

基金资助:中国肝炎防治基金资助项目（WBEXJS2018001）；镇江市社会发展项目（SH2018028）

通讯作者: 邹圣强（通讯作者），主任医师，硕士生导师，E-mail: 1210xyz@163.com

作者简介: 姚雅极（1990—），女，住院医师，硕士，主要从事急危重症救治等研究

引用本文:

姚雅极，邹圣强，胡佳民，吉芳，赵群，周建国，庄涛，张凯，严孝馨，江竹月，陈丽，刘津含. 老年肝衰竭患者预后影响因素分析及其预后模型的构建[J]. 江苏大学学报:医学版, 2021, 31(02): 143-146,151. YAO Yaji, ZOU Shengqiang, HU Jiamin, JI Fang, ZHAO Qun, ZHOU Jianguo, ZHUANG Tao, ZHANG Kai, YAN Xiaoxin, JIANG Zhuyue, CHEN Li, LIU Jinhan.

Analysis of prognostic factors in the elderly patients with liver failure and its construction of predictive model

. Journal of Jiangsu University(Medicine Edition), 2021, 31(02): 143-146,151.

链接本文:

http://zzs.ujs.edu.cn/xbyxb/CN/ 或 http://zzs.ujs.edu.cn/xbyxb/CN/Y2021/V31/I02/143

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