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ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 39 Issue 2
Feb.  2023
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Article Navigation >  Journal of Clinical Hepatology  > 2023  >  39(2): 307-315

Value of indocyanine green clearance test combined with total bilirubin actual resident rate in evaluating the short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure after artificial liver support system therapy

DOI: 10.3969/j.issn.1001-5256.2023.02.009

  • Department of Infectious Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China

Research funding:

Medical Science and Technology Project of the Health Commission of Sichuan Province (21PJ098)

More Information
  • Corresponding author: DENG Cunliang, dengcunl64@vip.sina.com (ORCID: 0000-0002-9120-8661)
  • Received Date: 2022-07-19
  • Accepted Date: 2022-08-25
  • Published Date: 2023-02-20
    Abstract
  •   Objective  To establish a new model of indocyanine green (ICG) clearance test combined with total bilirubin actual resident rate (TBARR) for predicting the short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) treated with artificial liver support system (ALSS) therapy.  Methods  A retrospective analysis was performed for the clinical data of 136 patients with HBV-ACLF who underwent ALSS therapy in Department of Infectious Diseases, The Affiliated Hospital of Southwest Medical University, from June 2017 to July 2021, and according to the prognosis at 3-month follow-up, they were divided into survival group with 92 patients and death group with 44 patients. Related indicators were measured at the time of the confirmed diagnosis of ACLF, including biochemical parameters, coagulation, indocyanine green retention rate at 15 minutes (ICGR15), and effective hepatic blood flow (EHBF), and related indices were calculated, including Model for End-Stage Liver Disease (MELD) score, MELD difference (ΔMELD), Child-Turcotte-Pugh (CTP) score, total bilirubin clearance rate (TBCR), total bilirubin rebound rate (TBRR), and TBARR. The Mann-Whitney U test was used for comparison of continuous data with skewed distribution between two groups; the chi-square test was used for comparison of categorical data between groups. A binary logistic regression analysis was used to establish a combined predictive model for the prognosis of HBV-ACLF after ALSS therapy. The area under the ROC curve (AUC) was used to compare the accuracy of various models in judging the short-term prognosis of patients with HBV-ACLF after ALSS therapy, and the Z test was used for comparison of AUC.  Results  There were significant differences between the death group and the survival group in MELD score, ΔMELD, CTP score, ICGR15, EHBF, TBRR, TBARR, neutrophil count, percentage of neutrophils, lymphocyte count, platelet count, alkaline phosphatase, gamma-glutamyl transpeptidase, total bilirubin, albumin, prothrombin time, international normalized ratio, prothrombin time activity, prealbumin, fibrinogen, serum sodium, age, and the incidence rate of hepatic encephalopathy (all P < 0.05). The multivariate logistic regression analysis showed that age (odds ratio [OR]=1.096, 95% confidence interval [CI]: 1.056-1.137, P < 0.001), neutrophil count (OR=1.214, 95%CI: 1.044-1.411, P=0.012), TBRR (OR=0.989, 95%CI: 0.982-0.996, P=0.001), TBARR (OR=1.073, 95%CI: 1.049-1.098, P < 0.001), ΔMELD (OR=1.480, 95%CI: 1.288-1.701, P < 0.001), CTP score (OR=2.081, 95%CI: 1.585-2.732, P < 0.001), and ICGR15(OR=1.116, 95%CI: 1.067-1.168, P < 0.001) were independent influencing factors for short-term mortality in patients with HBV-ACLF after ALSS therapy. The binary logistic regression analysis was used to establish four combined predictive models for predicting the prognosis of HBV-ACLF after ALSS therapy, i.e., TBRR-ICGR15, TBARR-ICGR15, TBARR-ICGR15-ΔMELD, and TBARR-ICGR15-ΔMELD-age, with an AUC of 0.830, 0.867, 0.900, and 0.917, respectively, and the combined predictive models had a larger AUC than each index alone (age, neutrophil count, TBRR, TBARR, ΔMELD, MELD score, CTP score, and ICGR15), among which the TBARR-ICGR15-ΔMELD-age model had the largest AUC. The combined models TBARR-ICGR15-ΔMELD and TBARR-ICGR15-ΔMELD-age had sensitivities and specificities of > 80%.  Conclusion  The combined predictive model established by ICGR15 and TBARR has a good value for in predicting the short-term prognosis of patients with HBV-ACLF after ALSS therapy, and the combined predictive model has a better accuracy than the single model in judging prognosis.

     

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    • References(22)
  • [1]
    WU B, DU LY, MA YJ, et al. Effects of different combinations of artificial liver support system on efficacy and inflammatory indexes of patients with hepatitis B virus-related acute-on-chronic liver failure in early and middle stages[J/CD]. Chin J Liver Dis (Electronic Version), 2021, 13(1): 32-38. DOI: 10.3969/j.issn.1674-7380.2021.01.006.

    吴蓓, 杜凌遥, 马元吉, 等. 不同组合人工肝支持系统治疗乙型肝炎病毒相关早、中期慢加急性肝衰竭患者的疗效及对炎症指标的影响[J/CD]. 中国肝脏病杂志(电子版), 2021, 13(1): 32-38. DOI: 10.3969/j.issn.1674-7380.2021.01.006.
    [2]
    WANG XL, SHANG HL. Short-term prognosis evaluation of indocyanine green clearance test combined with AFP in HBV-associated acute-on-chronic liver failure[J]. Chin Hepatol, 2015, 20(9): 663-666. DOI: 10.3969/j.issn.1008-1704.2015.09.002.

    王晓霖, 尚红玲. 吲哚菁绿清除试验联合甲胎蛋白对HBV相关慢加急性肝衰竭患者短期预后的评价[J]. 肝脏, 2015, 20(9): 663-666. DOI: 10.3969/j.issn.1008-1704.2015.09.002.
    [3]
    MA CH, CHEN Y, CHEN CW, et al. Prognostic value of indocyanine green and liver reserve function in acute and acute - on - chronic liver failure patients[J]. J Clin Hepatol, 2012, 28(5): 372-375. DOI: 10.3969/j.issn.1001-5256.2012.05.014.

    马春华, 陈煜, 陈成伟, 等. 吲哚菁绿清除试验对急性/慢加急性肝衰竭患者预后的评价[J]. 临床肝胆病杂志, 2012, 28(5): 372-375. DOI: 10.3969/j.issn.1001-5256.2012.05.014.
    [4]
    DU HL, HE HY, XIAO CJ, et al. Value of indocyanine green clearance test in predicting the short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure[J]. J Clin Hepatol, 2019, 35(12): 2759-2764. DOI: 10.3969/j.issn.1001-5256.2019.12.024.

    都泓莲, 何鸿雁, 肖慈君, 等. 吲哚菁绿清除试验对HBV相关慢加急性肝衰竭患者短期预后的评估[J]. 临床肝胆病杂志, 2019, 35(12): 2759-2764. DOI: 10.3969/j.issn.1001-5256.2019.12.024.
    [5]
    Liver Failure and Artificial Liver Group, Branch of lnfectious Diseases, Chinese Medical Association. Guideline for non-bioartificial liver support systems in treatment of liver failure: 2016 update[J]. Chin J Clin Infect Dis, 2016, 9(2): 97-103. DOI: 10.3760/cma.j.issn.1674-2397.2016.02.001.

    中华医学会感染病学分会肝衰竭与人工肝学组. 非生物型人工肝治疗肝衰竭指南(2016年版)[J]. 中华临床感染病杂志, 2016, 9(2): 97-103. DOI: 10.3760/cma.j.issn.1674-2397.2016.02.001.
    [6]
    XIN KF, LI M, LI SS, et al. Role of TBARR, TBRR and TBCR in evaluating prognosis of patients with acute-on-chronic liver failure after plasma exchange therapy[J]. Shandong Med J, 2018, 58(25): 44-46. DOI: 10.3969/j.issn.1002-266X.2018.25.012.

    辛克锋, 李铭, 李莎莎, 等. TBARR、TBRR、TBCR在血浆置换治疗后慢加急性肝衰竭患者预后评估中的作用[J]. 山东医药, 2018, 58(25): 44-46. DOI: 10.3969/j.issn.1002-266X.2018.25.012.
    [7]
    WANG M, ZHOU WL, CHEN F, et al. Correlation between the level of serum total bilirubin change after artificial liver treatment and the prognosis of patients with acute-on-chronic liver failure[J]. Pract J Clin Med, 2016, 13(5): 54-57, 58. DOI: 10.3969/j.issn.1672-6170.2016.05.013.

    王铭, 周威龙, 陈芳, 等. 人工肝治疗慢加急性肝功能衰竭后血清总红胆素变化水平与预后分析[J]. 实用医院临床杂志, 2016, 13(5): 54-57, 58. DOI: 10.3969/j.issn.1672-6170.2016.05.013.
    [8]
    Chinese Society of Infectious Diseases, Chinese Medical Association, Chinese Society of Hepatology, Chinese Medical Association. Guidelines for the prevention and treatment of chronic hepatitis B (version 2019)[J]. J Clin Hepatol, 2019, 35(12): 2648-2669. DOI: 10.3969/j.issn.1001-5256.2019.12.007.

    中华医学会感染病学分会, 中华医学会肝病学分会. 慢性乙型肝炎防治指南(2019年版)[J]. 临床肝胆病杂志, 2019, 35(12): 2648-2669. DOI: 10.3969/j.issn.1001-5256.2019.12.007.
    [9]
    Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, Chinese Medical Association; Severe Liver Disease and Artificial Liver Group, Chinese Society of Hepatology, Chinese Medical Association. Guideline for diagnosis and treatment of liver failure(2018)[J]. J Clin Hepatol, 2019, 35(1): 38-44. DOI: 10.3969/j.issn.1001-5256.2019.01.007.

    中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组. 肝衰竭诊治指南(2018年版)[J]. 临床肝胆病杂志, 2019, 35(1): 38-44. DOI: 10.3969/j.issn.1001-5256.2019.01.007.
    [10]
    MURRAY-LYON IM, PUGH RN, NUNNERLEY HB, et al. Treatment of bleeding oesophageal varices by infusion of vasopressin into the superior mesenteric artery[J]. Gut, 1973, 14(1): 59-63. DOI: 10.1136/gut.14.1.59.
    [11]
    KAMATH PS, WIESNER RH, MALINCHOC M, et al. A model to predict survival in patients with end-stage liver disease[J]. Hepatology, 2001, 33(2): 464-470. DOI: 10.1053/jhep.2001.22172.
    [12]
    SARIN SK, CHOUDHURY A, SHARMA MK, et al. Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update[J]. Hepatol Int, 2019, 13(4): 353-390. DOI: 10.1007/s12072-019-09946-3.
    [13]
    FAN Q, LI Z. Liver transplantation for acute-on-chronic liver failure[J]. Ogran Transplant, 2022, 13(3): 333-337. DOI: 10.3969/j.issn.1674-7445.2022.03.008.

    范祺, 李照. 慢加急性肝衰竭的肝移植治疗[J]. 器官移植, 2022, 13(3): 333-337. DOI: 10.3969/j.issn.1674-7445.2022.03.008.
    [14]
    FAN Z, ENQIANG C, YAO DL, et al. Neutrophil-lymphocyte ratio predicts short term mortality in patients with hepatitis B virus-related acute-on-chronic liver failure treated with an artificial liver support system[J]. PLoS One, 2017, 12(4): e0175332. DOI: 10.1371/journal.pone.0175332.
    [15]
    YANG Z, ZHANG Z, CHENG Q, et al. Plasma perfusion combined with plasma exchange in chronic hepatitis B-related acute-on-chronic liver failure patients[J]. Hepatol Int, 2020, 14(4): 491-502. DOI: 10.1007/s12072-020-10053-x.
    [16]
    YAO J, LI S, ZHOU L, et al. Therapeutic effect of double plasma molecular adsorption system and sequential half-dose plasma exchange in patients with HBV-related acute-on-chronic liver failure[J]. J Clin Apher, 2019, 34(4): 392-398. DOI: 10.1002/jca.21690.
    [17]
    XU XW, XIE ZY. The development and clinical application of L's artificial liver technology[J]. Chin J Infect Dis, 2019, 37(9): 518-522. DOI: 10.3760/cma.j.issn.1000-6680.2019.09.002.

    徐小微, 谢中阳. 李氏人工肝技术的发展和临床应用[J]. 中华传染病杂志, 2019, 37(9): 518-522. DOI: 10.3760/cma.j.issn.1000-6680.2019.09.002.
    [18]
    LIU YG, LU JH, YAN HM, et al. The establishment and verification of prognosis evaluation model for HBV related chronic and acute liver failure[J]. Tianjin Med J, 2021, 49(9): 981-986. DOI: 10.11958/20211051.

    刘勇钢, 卢建华, 闫会敏, 等. HBV相关慢加急性肝衰竭预后评估模型的建立与验证[J]. 天津医药, 2021, 49(9): 981-986. DOI: 10.11958/20211051.
    [19]
    HUANG BB, NING L, LI WY, et al. Establishment of a predictive model for the prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure treated with plasma exchange and double plasma molecular adsorption system alone or in combination[J]. J Clin Hepatol, 2021, 37(12): 2802-2807. DOI: 10.3969/j.issn.1001-5256.2021.12.015.

    黄贝贝, 宁玲, 李文渊, 等. 血浆置换与双重血浆分子吸附系统单用或联合使用治疗HBV相关慢加急性肝衰竭患者预后预测模型的建立与评估[J]. 临床肝胆病杂志, 2021, 37(12): 2802-2807. DOI: 10.3969/j.issn.1001-5256.2021.12.015.
    [20]
    ZHANG Z, YANG Z, CHENG Q, et al. Establishment and validation of a prognostic model for hepatitis B virus-related acute-on-chronic liver failure patients with bacterial infection[J]. Hepatol Int, 2022, 16(1): 38-47. DOI: 10.1007/s12072-021-10268-6.
    [21]
    WANG ZC, SHAO JG, GU EL. Short-term predictive effect of total bilirubin rebound rate on chronic plus subacute liver failure treated with artificial liver[J]. Chin J Infect Dis, 2013, 31(11): 678-680. DOI: 10.3760/cma.j.issn.1000-6680.2013.11.009.

    王忠成, 邵建国, 顾尔莉. 总胆红素反弹率对人工肝治疗慢加亚急性肝功能衰竭的短期预测[J]. 中华传染病杂志, 2013, 31(11): 678-680. DOI: 10.3760/cma.j.issn.1000-6680.2013.11.009.
    [22]
    QIN T, LI QL. The short-term predictive value of total bilirubin rebound rate in the treatment of chronic hepatitis B virus related acute-on-chronic liver failure by plasma exchange[J]. Chin J Clin Gastroenterol, 2021, 33(5): 351-355. DOI: 10.3870/lcxh.j.issn.1005-541X.2021.05.11.

    覃婷, 李前龙. 总胆红素反弹率对血浆置换治疗乙肝相关慢加急性肝衰竭的短期预测价值[J]. 临床消化病杂志, 2021, 33(5): 351-355. DOI: 10.3870/lcxh.j.issn.1005-541X.2021.05.11.
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