目的:探讨肝纤维化相关评分对慢加急性乙型肝炎肝衰竭(acute-on-chronic hepatitis B liver failure, ACHBLF)患者短期预后的评估价值。方法:回顾性纳入2010年1月至2024年7月于山东大学齐鲁医院肝病科住院并符合纳入与排除标准的261名AC...目的:探讨肝纤维化相关评分对慢加急性乙型肝炎肝衰竭(acute-on-chronic hepatitis B liver failure, ACHBLF)患者短期预后的评估价值。方法:回顾性纳入2010年1月至2024年7月于山东大学齐鲁医院肝病科住院并符合纳入与排除标准的261名ACHBLF患者,收集入院24 h内的一般临床资料、FIB-4指数(fibrosis 4 Score, FIB-4)、APRI评分(aspartate aminotransferase to platelet ratio index, APRI)等,根据是否有肝硬化基础分组并进行临床特征比较;探究FIB-4、APRI与临床检验指标的相关性;探究人群FIB-4指数、APRI评分的分布情况;优选指标阈值效应分析确定拐点,进行肝衰竭患者预后分析。结果:FIB-4与天门冬氨酸氨基转移酶(aspartate aminotransferase, AST)、国际标准化比值(international normalized ratio, INR)、终末期肝病模型(model for end-stage liver disease, MELD)呈正相关;与白蛋白(albumin, ALB)、凝血酶原活动度(prothrombin activity, PTA)呈负相关;APRI评分与丙氨酸氨基转移酶(alanine aminotransferase, ALT)、AST、总胆红素(total bilirubin, TBIL)、MELD评分呈正相关;与PTA呈负相关。APRI评分在肝硬化和非肝硬化组ACHBLF患者中无显著性差异(P = 0.551)。选择FIB-4进行阈值效应分析,发现ACHBLF患者预后不良的最佳阈值为11.4。总体ACHBLF中,FIB-4指数 ≥ 11.4的患者28天生存率为43.24%,低于FIB-4 P = 0.011);FIB-4指数 ≥ 11.4的患者90天生存率为43.24%,低于FIB-4 P = 0.017);差异有统计学意义(P P = 0.010);FIB-4指数 ≥ 11.4的患者90天生存率为45.16%,低于FIB-4 P = 0.021),差异有统计学意义(P Objective: To investigate the evaluation value of liver fibrosis-related serum model Fib-4 index and APRI score for the short-term prognosis of acute-on-chronic hepatitis B liver failure (ACHBLF). Methods: A total of 261 ACHBLF patients who were hospitalized in the Department of Hepatology, Qilu Hospital of Shandong University from January 2010 to July 2024 and met the inclusion and exclusion criteria were retrospectively enrolled. General clinical data and fibrosis 4 Score (FIB-4) and aspartate aminotransferase to platelet ratio index (APRI) within 24 hours after admission were collected. According to whether there was a basis of liver cirrhosis, the patients were divided into two groups and their clinical characteristics were compared. The correlation between FIB-4, APRI and clinical test index was explored. The distribution of FIB-4 index and APRI score in the population was explored. The distribution of FIB-4 index and APRI score in the population was explored. The threshold effect analysis of the optimal index was used to determine the inflection point and to analyze the prognosis of patients with liver failure. Results: In ACHBLF patients, FIB-4 was positively correlated with aspartate aminotransferase (AST), international normalized ratio (INR) and model for end-stage liver disease (MELD). APRI was negatively correlated with albumin (ALB), prothrombin activity (PTA), systemic immune-inflammatory index (SII), platelet to lymphocyte ratio (PLR) and neutrophil-to-platelet ratio (NPR), and positively correlated with alanine aminotransferase (ALT), AST, total bilirubin (TBIL) and MELD score. It was negatively correlated with PTA, SII and PLR. The distribution of the study population suggested that FIB-4 index (P = 0.013) was more significantly different from APRI score (P = 0.551) in ACHBLF patients with cirrhosis and without cirrhosis. FIB-4 was selected for threshold effect analysis, and the optimal threshold for poor prognosis in ACHBLF patients was 11.4. In all ACHBLF patients, the 28-day survival rate of patients with FIB-4 index ≥ 11.4 was 43.24%, which was lower than 65.18% of patients with FIB-4 index P = 0.011). The 90-day survival rate of patients with FIB-4 index ≥ 11.4 was 43.24%, which was lower than that of patients with FIB-4 index P = 0.017). The difference was statistically significant (P P = 0.010). The 90-day survival rate of patients with FIB-4 index ≥ 11.4 was 45.16%, which was lower than 67.41% of patients with FIB-4 index P = 0.021). The difference was statistically significant (P < 0.05). Conclusion: The 28-day and 90-day survival rates of patients with FIB-4 index ≥ 11.4 were lower than those with FIB-4 index < 11.4 in all ACHBLF patients and ACHBLF patients with cirrhosis.展开更多
Background and Aims:Aspartate aminotransferase-toplatelet ratio index(APRI)and fibrosis-4 index(FIB-4)are widely used to assess liver fibrosis in chronic hepatitis B virus(HBV)infection.Currently,the definition of nor...Background and Aims:Aspartate aminotransferase-toplatelet ratio index(APRI)and fibrosis-4 index(FIB-4)are widely used to assess liver fibrosis in chronic hepatitis B virus(HBV)infection.Currently,the definition of normal alanine aminotransferase(ALT)is controversial.We aimed to examine the diagnostic value of APRI and FIB-4 in chronic HBV carriers with different upper limits of normal(ULNs)for ALT.Methods:581 chronic HBV carriers were divided into the following four groups based on different ULNs for ALT:chronic HBV carriers I,II,III,and IV.Furthermore,106 chronic HBV carriers formed an external validation group.Predictive values of APRI and FIB-4 were elucidated using the area under the curve(AUC).A liver fibrosis-predictive model-GPSA(named for its measure of gamma glutamyl transpeptidase,platelet count,HBsAg and albumin)was developed using multivariate logistic regression analysis.Results:In chronic HBV carriers I,the AUCs of APRI and FIB-4 were 0.680 and 0.609 for significant fibrosis and 0.678 and 0.661 for cirrhosis,respectively.The AUCs of GPSA for significant fibrosis in the training group,internal group,and external validation group were 0.877,0.837,and 0.871,respectively.The diagnostic value of GPSA differed among chronic HBV carriers I,II,III,and IV,with AUCs for significant fibrosis being 0.857,0.853,0.868,and 0.905 and AUCs for cirrhosis being 0.901,0.905,0.886,and 0.913,respectively.GPSA showed a higher diagnostic value than APRI and FIB-4 for predicting significant fibrosis in the four groups.Conclusions:The GPSA model allows for accurate diagnosis of liver fibrosis in chronic HBV carriers with different ULN for ALT.展开更多
目的 探讨基于4个因素的纤维化指数(fibrosis index based on four factors,FIB-4)在长期接受抗病毒治疗的慢性乙型肝炎(chronic hepatitis B,CHB)患者前瞻队列人群中对发生肝细胞癌(hepatocellular carcinoma,HCC)的预测能力。方法 收...目的 探讨基于4个因素的纤维化指数(fibrosis index based on four factors,FIB-4)在长期接受抗病毒治疗的慢性乙型肝炎(chronic hepatitis B,CHB)患者前瞻队列人群中对发生肝细胞癌(hepatocellular carcinoma,HCC)的预测能力。方法 收集2008年10月至2021年7月首都医科大学附属北京地坛医院829例接受口服抗病毒治疗或在研究开始前接受治疗的成年CHB患者的基线数据,每3~6个月进行1次随访,HCC经腹超声、腹部计算机断层扫描(computed tomography,CT)或磁共振成像(magnetic resonance imaging,MRI)或肝血管造影检查或HCC的细胞学/组织学诊断。结果 共纳入764例CHB患者,中位随访时间为8.8(6.7~10.6)年。多因素Cox回归分析显示,年龄、HCC家族史、饮酒、肝硬化和FIB-4均为CHB患者HCC发病独立风险预测因子,差异均有统计学意义(P<0.001)。通过限制性立条图RCS分析,随着FIB-4指数的增加HCC发生风险呈非线性升高。相对于FIB-4指数<1.4组,FIB-4指数≥1.4组HCC的HR为8.89(95%CI:3.16~25.07),校正多因素影响后HR为4.84(95%CI:1.64~14.34)。肝硬化患者发生HCC的HR为3.46(95%CI:1.69~7.07)。中介效应模型分析,FIB-4指数与肝硬化有中介效应,其中有40.25%通过肝硬化间接影响HCC的发生。结论 FIB-4指数在预测接受抗病毒治疗的CHB患者的HCC风险方面具有优势。可用于临床实践,以帮助决策长期HCC监测策略,尤其是对中度和高危患者。展开更多
BACKGROUND Previous studies have reported the high predictive accuracy of 4C Mortality Score derived at hospital admission in coronavirus disease 2019(COVID-19)patients.Very few studies have assessed it at intensive c...BACKGROUND Previous studies have reported the high predictive accuracy of 4C Mortality Score derived at hospital admission in coronavirus disease 2019(COVID-19)patients.Very few studies have assessed it at intensive care unit(ICU)admission and compared it with the Acute Physiology and Chronic Health Evaluation(APACHE)II score.There are no studies comparing its accuracy with APACHE III score.AIM To describe the characteristics and outcomes of patients admitted to ICU with COVID-19 infection and to compare the accuracy of 4C score and APACHE score in predicting mortality in these patients.METHODS We conducted this retrospective cohort study using an electronic database in a tertiary ICU in Sydney.We included all adult patients(age>16 years)admitted to ICU with COVID-19 infection over a 5-month period(July 1,2021 to November 30,2021).We collected the data on demographics,clinical characteristics,interventions and outcomes for all patients.We calculated the 4C Mortality Score for each patient using eight variables as described previously.We compared the predictive accuracy of 4C Mortality Score at hospital and ICU admission and APACHE II and III scores by area under the receiver operating characteristic curve(AUROC).We determined the optimal cut-off value for each of these scores using the‘nearest’method and its 95%confidence interval by bootstrapping.RESULTS A total of 140 patients(62%males,mean age 56±17 years,mean APACHE II score 13±57)were included in the study.Nineteen(13.6%)of 140 patients died in the hospital.Compared to survivors,the non-survivors were older,males,had more comorbidities,higher rate of mechanical ventilation and vasopressor use.The AUROC for the 4C Mortality Score at hospital and ICU admission and APACHE II and II score was 0.75,0.80.0.75 and 0.79 respectively.The optimal cut-off value for these four scores was 9,10,14 and 56 respectively.The cut-point for all the scores had higher sensitivity than specificity.CONCLUSION The 4C score at ICU admission had a higher accuracy in predicting mortality than the 4C score at hospital admission.The predictive accuracy was similar to that for APACHE III score.The 4C score at ICU admission needs to be validated in future studies.展开更多
目的探讨FIB-4(fibrosis index based on the 4 factor)指数对慢性乙型肝炎患者肝纤维化诊断价值。方法检测86例慢性乙肝患者血清ALT(谷丙转氨酶)、AST(谷草转氨酶)、PLT(血小板)等指标,根据病理肝纤维化分期设定两个判定点,分别为显著...目的探讨FIB-4(fibrosis index based on the 4 factor)指数对慢性乙型肝炎患者肝纤维化诊断价值。方法检测86例慢性乙肝患者血清ALT(谷丙转氨酶)、AST(谷草转氨酶)、PLT(血小板)等指标,根据病理肝纤维化分期设定两个判定点,分别为显著纤维化(≥S2级)和肝硬化(S4级),采用FIB-4指数加以评分,以肝组织病理学检查作对比,根据受试者工作特征曲线(AU-ROCs)评价FIB-4对于肝纤维化的诊断价值。结果FIB-4指数采用AUROCs加以评价,显示FIB-4≥S2级(显著纤维化)AUC曲线下面积为0.813,以1.56分值为界值,诊断显著肝纤维化敏感性、特异性、PPV和NPV分别达到86.21%、71.43%、86.2%和71.4%。S4级(肝硬化)AUC曲线下面积为0.802,以2.2分值为界值,诊断肝硬化敏感性、特异性、PPV和NPV分别达到87.5%、67.14%、37.8%和95.9%。结论FIB-4指数是一种简单易行、预测结果可靠的非侵入诊断方法,在一定程度上可替代肝活检。展开更多
文摘目的:探讨肝纤维化相关评分对慢加急性乙型肝炎肝衰竭(acute-on-chronic hepatitis B liver failure, ACHBLF)患者短期预后的评估价值。方法:回顾性纳入2010年1月至2024年7月于山东大学齐鲁医院肝病科住院并符合纳入与排除标准的261名ACHBLF患者,收集入院24 h内的一般临床资料、FIB-4指数(fibrosis 4 Score, FIB-4)、APRI评分(aspartate aminotransferase to platelet ratio index, APRI)等,根据是否有肝硬化基础分组并进行临床特征比较;探究FIB-4、APRI与临床检验指标的相关性;探究人群FIB-4指数、APRI评分的分布情况;优选指标阈值效应分析确定拐点,进行肝衰竭患者预后分析。结果:FIB-4与天门冬氨酸氨基转移酶(aspartate aminotransferase, AST)、国际标准化比值(international normalized ratio, INR)、终末期肝病模型(model for end-stage liver disease, MELD)呈正相关;与白蛋白(albumin, ALB)、凝血酶原活动度(prothrombin activity, PTA)呈负相关;APRI评分与丙氨酸氨基转移酶(alanine aminotransferase, ALT)、AST、总胆红素(total bilirubin, TBIL)、MELD评分呈正相关;与PTA呈负相关。APRI评分在肝硬化和非肝硬化组ACHBLF患者中无显著性差异(P = 0.551)。选择FIB-4进行阈值效应分析,发现ACHBLF患者预后不良的最佳阈值为11.4。总体ACHBLF中,FIB-4指数 ≥ 11.4的患者28天生存率为43.24%,低于FIB-4 P = 0.011);FIB-4指数 ≥ 11.4的患者90天生存率为43.24%,低于FIB-4 P = 0.017);差异有统计学意义(P P = 0.010);FIB-4指数 ≥ 11.4的患者90天生存率为45.16%,低于FIB-4 P = 0.021),差异有统计学意义(P Objective: To investigate the evaluation value of liver fibrosis-related serum model Fib-4 index and APRI score for the short-term prognosis of acute-on-chronic hepatitis B liver failure (ACHBLF). Methods: A total of 261 ACHBLF patients who were hospitalized in the Department of Hepatology, Qilu Hospital of Shandong University from January 2010 to July 2024 and met the inclusion and exclusion criteria were retrospectively enrolled. General clinical data and fibrosis 4 Score (FIB-4) and aspartate aminotransferase to platelet ratio index (APRI) within 24 hours after admission were collected. According to whether there was a basis of liver cirrhosis, the patients were divided into two groups and their clinical characteristics were compared. The correlation between FIB-4, APRI and clinical test index was explored. The distribution of FIB-4 index and APRI score in the population was explored. The distribution of FIB-4 index and APRI score in the population was explored. The threshold effect analysis of the optimal index was used to determine the inflection point and to analyze the prognosis of patients with liver failure. Results: In ACHBLF patients, FIB-4 was positively correlated with aspartate aminotransferase (AST), international normalized ratio (INR) and model for end-stage liver disease (MELD). APRI was negatively correlated with albumin (ALB), prothrombin activity (PTA), systemic immune-inflammatory index (SII), platelet to lymphocyte ratio (PLR) and neutrophil-to-platelet ratio (NPR), and positively correlated with alanine aminotransferase (ALT), AST, total bilirubin (TBIL) and MELD score. It was negatively correlated with PTA, SII and PLR. The distribution of the study population suggested that FIB-4 index (P = 0.013) was more significantly different from APRI score (P = 0.551) in ACHBLF patients with cirrhosis and without cirrhosis. FIB-4 was selected for threshold effect analysis, and the optimal threshold for poor prognosis in ACHBLF patients was 11.4. In all ACHBLF patients, the 28-day survival rate of patients with FIB-4 index ≥ 11.4 was 43.24%, which was lower than 65.18% of patients with FIB-4 index P = 0.011). The 90-day survival rate of patients with FIB-4 index ≥ 11.4 was 43.24%, which was lower than that of patients with FIB-4 index P = 0.017). The difference was statistically significant (P P = 0.010). The 90-day survival rate of patients with FIB-4 index ≥ 11.4 was 45.16%, which was lower than 67.41% of patients with FIB-4 index P = 0.021). The difference was statistically significant (P < 0.05). Conclusion: The 28-day and 90-day survival rates of patients with FIB-4 index ≥ 11.4 were lower than those with FIB-4 index < 11.4 in all ACHBLF patients and ACHBLF patients with cirrhosis.
基金supported by Fujian Provincial Health Technology Project(No.2019-ZQN-60)Natural Science Fundation of Fujian Province(No.2019J01432)National Natural Science Foundation of China(No.81670528)。
文摘Background and Aims:Aspartate aminotransferase-toplatelet ratio index(APRI)and fibrosis-4 index(FIB-4)are widely used to assess liver fibrosis in chronic hepatitis B virus(HBV)infection.Currently,the definition of normal alanine aminotransferase(ALT)is controversial.We aimed to examine the diagnostic value of APRI and FIB-4 in chronic HBV carriers with different upper limits of normal(ULNs)for ALT.Methods:581 chronic HBV carriers were divided into the following four groups based on different ULNs for ALT:chronic HBV carriers I,II,III,and IV.Furthermore,106 chronic HBV carriers formed an external validation group.Predictive values of APRI and FIB-4 were elucidated using the area under the curve(AUC).A liver fibrosis-predictive model-GPSA(named for its measure of gamma glutamyl transpeptidase,platelet count,HBsAg and albumin)was developed using multivariate logistic regression analysis.Results:In chronic HBV carriers I,the AUCs of APRI and FIB-4 were 0.680 and 0.609 for significant fibrosis and 0.678 and 0.661 for cirrhosis,respectively.The AUCs of GPSA for significant fibrosis in the training group,internal group,and external validation group were 0.877,0.837,and 0.871,respectively.The diagnostic value of GPSA differed among chronic HBV carriers I,II,III,and IV,with AUCs for significant fibrosis being 0.857,0.853,0.868,and 0.905 and AUCs for cirrhosis being 0.901,0.905,0.886,and 0.913,respectively.GPSA showed a higher diagnostic value than APRI and FIB-4 for predicting significant fibrosis in the four groups.Conclusions:The GPSA model allows for accurate diagnosis of liver fibrosis in chronic HBV carriers with different ULN for ALT.
文摘目的 探讨基于4个因素的纤维化指数(fibrosis index based on four factors,FIB-4)在长期接受抗病毒治疗的慢性乙型肝炎(chronic hepatitis B,CHB)患者前瞻队列人群中对发生肝细胞癌(hepatocellular carcinoma,HCC)的预测能力。方法 收集2008年10月至2021年7月首都医科大学附属北京地坛医院829例接受口服抗病毒治疗或在研究开始前接受治疗的成年CHB患者的基线数据,每3~6个月进行1次随访,HCC经腹超声、腹部计算机断层扫描(computed tomography,CT)或磁共振成像(magnetic resonance imaging,MRI)或肝血管造影检查或HCC的细胞学/组织学诊断。结果 共纳入764例CHB患者,中位随访时间为8.8(6.7~10.6)年。多因素Cox回归分析显示,年龄、HCC家族史、饮酒、肝硬化和FIB-4均为CHB患者HCC发病独立风险预测因子,差异均有统计学意义(P<0.001)。通过限制性立条图RCS分析,随着FIB-4指数的增加HCC发生风险呈非线性升高。相对于FIB-4指数<1.4组,FIB-4指数≥1.4组HCC的HR为8.89(95%CI:3.16~25.07),校正多因素影响后HR为4.84(95%CI:1.64~14.34)。肝硬化患者发生HCC的HR为3.46(95%CI:1.69~7.07)。中介效应模型分析,FIB-4指数与肝硬化有中介效应,其中有40.25%通过肝硬化间接影响HCC的发生。结论 FIB-4指数在预测接受抗病毒治疗的CHB患者的HCC风险方面具有优势。可用于临床实践,以帮助决策长期HCC监测策略,尤其是对中度和高危患者。
文摘BACKGROUND Previous studies have reported the high predictive accuracy of 4C Mortality Score derived at hospital admission in coronavirus disease 2019(COVID-19)patients.Very few studies have assessed it at intensive care unit(ICU)admission and compared it with the Acute Physiology and Chronic Health Evaluation(APACHE)II score.There are no studies comparing its accuracy with APACHE III score.AIM To describe the characteristics and outcomes of patients admitted to ICU with COVID-19 infection and to compare the accuracy of 4C score and APACHE score in predicting mortality in these patients.METHODS We conducted this retrospective cohort study using an electronic database in a tertiary ICU in Sydney.We included all adult patients(age>16 years)admitted to ICU with COVID-19 infection over a 5-month period(July 1,2021 to November 30,2021).We collected the data on demographics,clinical characteristics,interventions and outcomes for all patients.We calculated the 4C Mortality Score for each patient using eight variables as described previously.We compared the predictive accuracy of 4C Mortality Score at hospital and ICU admission and APACHE II and III scores by area under the receiver operating characteristic curve(AUROC).We determined the optimal cut-off value for each of these scores using the‘nearest’method and its 95%confidence interval by bootstrapping.RESULTS A total of 140 patients(62%males,mean age 56±17 years,mean APACHE II score 13±57)were included in the study.Nineteen(13.6%)of 140 patients died in the hospital.Compared to survivors,the non-survivors were older,males,had more comorbidities,higher rate of mechanical ventilation and vasopressor use.The AUROC for the 4C Mortality Score at hospital and ICU admission and APACHE II and II score was 0.75,0.80.0.75 and 0.79 respectively.The optimal cut-off value for these four scores was 9,10,14 and 56 respectively.The cut-point for all the scores had higher sensitivity than specificity.CONCLUSION The 4C score at ICU admission had a higher accuracy in predicting mortality than the 4C score at hospital admission.The predictive accuracy was similar to that for APACHE III score.The 4C score at ICU admission needs to be validated in future studies.
文摘目的探讨FIB-4(fibrosis index based on the 4 factor)指数对慢性乙型肝炎患者肝纤维化诊断价值。方法检测86例慢性乙肝患者血清ALT(谷丙转氨酶)、AST(谷草转氨酶)、PLT(血小板)等指标,根据病理肝纤维化分期设定两个判定点,分别为显著纤维化(≥S2级)和肝硬化(S4级),采用FIB-4指数加以评分,以肝组织病理学检查作对比,根据受试者工作特征曲线(AU-ROCs)评价FIB-4对于肝纤维化的诊断价值。结果FIB-4指数采用AUROCs加以评价,显示FIB-4≥S2级(显著纤维化)AUC曲线下面积为0.813,以1.56分值为界值,诊断显著肝纤维化敏感性、特异性、PPV和NPV分别达到86.21%、71.43%、86.2%和71.4%。S4级(肝硬化)AUC曲线下面积为0.802,以2.2分值为界值,诊断肝硬化敏感性、特异性、PPV和NPV分别达到87.5%、67.14%、37.8%和95.9%。结论FIB-4指数是一种简单易行、预测结果可靠的非侵入诊断方法,在一定程度上可替代肝活检。
