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肝硬化合并细菌性腹水患者30天内死亡预测模型的建立
Establishment of a predictive model of death within 30 days for patients with liver cirrhosis and bacterial ascites
文章发布日期:2019年09月29日  来源:  作者:黄云义, 王宪波  点击次数:227次  下载次数:44次

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【摘要】: 目的 探讨肝硬化合并细菌性腹水患者30 d内死亡的危险因素,并建立可以预测其30 d内死亡的预测模型。方法 回顾性收集2012年1月-2018年4月首都医科大学附属北京地坛医院收治的肝硬化合并细菌性腹水患者86例,对其进行为期30 d的随访观察,根据患者预后将其分为生存组(n=73例)与死亡组(n=13例)。符合正态分布的计量资料组间比较采用t检验,非正态分布的计量资料组间比较采用Mann-Whitney U检验,计数资料组间比较采用χ2检验。采用logistic回归分析探讨肝硬化合并细菌性腹水患者30 d内死亡的影响因素,并根据影响因素建立预测模型。用受试者工作特征曲线下面积(AUC)评估各独立影响因素和预测模型的预测价值。结果 logistic多因素回归分析发现腹水白蛋白[比值比(OR)=0.615,95%可信区间(95%CI):0.424~0.893,P=0.011]、中性粒细胞与淋巴细胞比值(NLR)(OR=1.170,95%CI:1.011~1.354,P=0.035)、MELD评分(OR=1.341,95%CI:1.111~1.618,P=0.002)在生存组与死亡组之间的差异具有统计学意义。根据多因素分析结果建立预测肝硬化合并细菌性腹水患者30 d内死亡的评分模型,该模型将患者分为30 d内死亡的高危组(评分≥2分)和低危组(评分<2分),两组患者30 d内病死率差异具有统计学意义(60.0% vs 5.6%, P<0.001)。结论 腹水白蛋白≤3.5 g/L、NLR≥6.5、MELD评分≥20是肝硬化合并细菌性腹水患者30 d内死亡的独立危险因素。在此基础上建立起来的预测模型可以很好评估其30 d内死亡的高危人群。
【Abstract】: Objective To investigate the risk factors for death within 30 days in patients with liver cirrhosis and bacterial ascites, and to establish a predictive model of death within 30 days. Methods A retrospective analysis was performed for the clinical data of 86 patients with liver cirrhosis and bacterial ascites who were admitted to Beijing Ditan Hospital, Capital Medical University, from January 2012 to April 2018. The patients were followed up for 30 days, and according to their prognosis, they were divided into survival group with 73 patients and death group with 13 patients. The t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups. A logistic regression analysis was used to investigate the influencing factors for death within 30 days in patients with liver cirrhosis and bacterial ascites, and a predictive model was established based on these influencing factors. The area under the receiver operating characteristic curve was used to evaluate the predictive value of each independent influencing factor and the predictive model. Results The multivariate logistic regression analysis showed that there were significant differences between the survival group and the death group in ascites albumin (odds ratio [OR]=0.615, 95% confidence interval [CI]: 0.424-0.893, P=0.011), neutrophil-to-lymphocyte ratio (NLR) (OR=1.170, 95%CI: 1.011-1.354, P=0.035), and Model for End-Stage Liver Disease (MELD) score (OR=1.341, 95% CI: 1.111-1.618, P=0.002). A scoring model was established based on the results of the multivariate analysis to predict death within 30 days in patients with liver cirrhosis and bacterial ascites, and based on this model, the patients were divided into high-risk group with death within 30 days (score ≥2 points) and low-risk group with death within 30 days (score <2 points). There was a significant difference in mortality rate with 30 days between the two groups (60.0% vs 5.6%, P<0.001). Conclusion Ascites albumin ≤3.5 g/L, NLR ≥6.5, and MELD score ≥20 are independent risk factors for death within 30 days in patients with liver cirrhosis and bacterial ascites. The predictive model established on this basis can effectively evaluate the population at high risk of death within 30 days.
【关键字】:肝硬化; 细菌性腹水; 腹膜炎; 预后; Logistic模型
【Key words】:liver cirrhosis; bacterial ascites; peritonitis; prognosis; logistic models
【引证本文】:HUANG YY, WANG XB. Establishment of a predictive model of death within 30 days for patients with liver cirrhosis and bacterial ascites[J]. J Clin Hepatol, 2019, 35(11): 2472-2477. (in Chinese)
黄云义, 王宪波. 肝硬化合并细菌性腹水患者30天内死亡预测模型的建立[J]. 临床肝胆病杂志, 2019, 35(11): 2472-2477.

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