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急性肝衰竭短期预后模型研究

, PP. 1864-1869

Keywords: 急性肝衰竭,Logistic回归,预后

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Abstract:

目的构建急性肝衰竭(acuteliverfailure,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SPSS19.0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ALF3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)(OR1.077,95%CI1.028~1.130,P=0.002),国际标准化比率(INR)(OR2.555,95%CI1.561~4.182,P=0.000),血钠(Na+)(OR0.938,95%CI0.883~0.996,P=0.037),腹水(OR2.804,95%CI1.140~6.892,P=0.025)和感染(OR5.348,95%CI2.268~12.610,P=0.000)。建立ALF短期预后模型(modelforacuteliverfailure,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(areaunderthecurveofROC,AUC)为0.952(95%CI0.907~0.997),高于MELD0.783(95%CI0.720~0.845)、MELD-Na0.825(95%CI0.762~0.887)、IMELD0.793(95%CI0.726~0.860)、UKELD0.841(95%CI0.781~0.901),均具有统计学差异(P<0.001)。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。

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