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ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 35 Issue 12
Dec.  2019
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Article Contents

Value of indocyanine green clearance test in predicting the short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure

DOI: 10.3969/j.issn.1001-5256.2019.12.024
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  • Received Date: 2019-08-10
  • Published Date: 2019-12-20
  • Objective To investigate the value of indocyanine green( ICG) clearance test in evaluating the short-term prognosis of patients with hepatitis B virus( HBV)-related acute-on-chronic liver failure( HBV-ACLF),to establish a new model for prognostic evaluation based on indocyanine green retention rate at 15 minutes( ICGR15) combined with Model for End-Stage Liver Disease( MELD) score and Child-Turcotte-Pugh( CTP) score,and to provide a basis for establishing an ideal model for the short-term prognosis of HBV-ACLF.Methods A total of 97 patients with HBV-ACLF who were admitted to Department of Infectious Diseases in The Affiliated Hospital of Southwest Medical University from June 2017 to January 2019 were enrolled and related clinical data were collected. According to the primary liver disease,these patients were divided into chronic hepatitis B( CHB) group and liver cirrhosis( LC) group; according to the outcome at 3-month follow-up,they were divided into death group and survival group. ICGR15,biochemical indices,and coagulation markers were measured at the time of confirmed diagnosis,and CTP and MELD scores were calculated. The t-test was used for comparison of normally distribu-ted 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,and a Spearman rank correlation analysis was used to investigate the correlation of ICGR15 with each variable. A binary logistic regression analysis was used to establish the combined predictive models of MELD-ICGR15 and CTP-ICGR15 for HBV-ACLF. The area under the receiver operating characteristic( ROC) curve( AUC)was used to compare the accuracy of these models in predicting the short-term prognosis of patients with HBV-ACLF,and the Medcalcdcal method was used for comparison of AUC. The maximum of Youden index( sensitivity + specificity-1) was calculated based on the sensitivity and misjudgment rate corresponding to each point on the ROC curve,and the optimal cut-off value for survival or death of patients with HBV-ACLF was determined. Results There were significant differences between the CHB group and the LC group in CTP score( t =-3. 245,P= 0. 002),albumin( Alb)( t = 2. 210,P = 0. 029),alanine aminotransferase( Z =-2. 572,P = 0. 010),and aspartate aminotransferase( Z=-1. 993,P = 0. 046). Compared with the CHB group,the LC group had significantly higher mortality rate( 37. 5% vs 17. 54%,χ2=4. 893,P = 0. 027) and incidence rate of peritonitis( 90% vs 64. 91%,χ2= 7. 945,P = 0. 005). In the CHB group,there were significant differences in ICGR15,MELD score,CTP score,total bilirubin,Alb,prothrombin time activity,prothrombin time,and international normalized ratio between the patients who died and those who survived( t = 3. 036,3. 878,3. 488,2. 756,-3. 049,-3. 954,2. 713,and 2. 717,all P < 0. 05); in the LC group,there were significant differences in ICGR15,CTP score,and Alb between the patients who died and those who survived( t = 3. 476,2. 79,and-2. 274,all P < 0. 05). Regardless of the presence or absence of LC,ICGR15 was positively correlated with MELD score( r = 0. 483 and 0. 35,both P < 0. 05) and CTP score( r = 0. 35 and 0. 411,both P < 0. 05). Based on the binary logistic regression analysis,the combined predictive models of MELD-ICGR15 and CTP-ICGR15 for HBV-ACLF were established,with an AUC of 0. 820 and 0. 847,respectively. The combined predictive models had a larger AUC than each index alone( ICGR15: 0. 787; MELD score: 0. 754;CTP score: 0. 795),and the CTP-ICGR15 model had the largest AUC. ICGR15 had a high sensitivity and a poor specificity,and the combined predictive models improved the specificity of ICGR15 alone; the CTP-ICGR15 model had a higher specificity than the MELD-ICGR15 model.Conclusion ICGR15 has a high sensitivity in predicting the short-term prognosis of HBV-ACLF,and combined predictive models have a higher accuracy than the models of a single index and can improve the specificity of the prediction based on ICGR15 alone. The combined model of CTP-ICGR15 has a higher predictive value than that of MELD-ICGR15.

     

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  • [1] MA CH,CHEN Y,CHEN CW,et al. Prognostic value of indocyanine green and liver reserve function in acute and acuteon-chronic liver failure patients[J]. J Clin Hepatol,2012,28(5):372-375.(in Chinese)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.
    [2] WU KL,ZHANG Y,HUANG J,et al. Model for end-stage liver disease combined with indocyanine green clearance test can effectively predict the prognosis of HBV-Associated acute-on-chronic liver failure[J]. J Sun Yat-Sen Univ(Medical Sciences),2018,39(6):935-940.(in Chinese)吴坤亮,张英,黄晶,等.终末期肝病模型评分联合吲哚菁绿清除实验预测HBV相关慢加急性肝衰竭预后[J].中山大学学报(医学科学版),2018,39(6):935-940.
    [3] Chinese Society of Hepatology and Chinese Society of Infectious Diseases Chinese,Medical Association. The guideline of prevention and treatment for chronic hepatitis B:A 2015 update[J]. J Clin Hepatol,2015,31(12):1941-1960.(in Chinese)中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2015年更新版)[J].临床肝胆病杂志,2015,31(12):1941-1960.
    [4] Liver Failure and Artificial Liver Group,Chinese Society of Infectious Diseases,CMA; Severe Liver Disease and Artificial Liver Group,Chinese Society of Hepatology,CMA. Guideline for diagnosis and treatment of liver failure(2018)[J]. J Clin Hepatol,2019,35(1):38-44.(in Chinese)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.
    [5] 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.
    [6] 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.
    [7] SARIN SK,KUMAR A,ALMEIDA JA,et al. Acute-on-chronic liver failure:Consensus recommendations of the Asian Pacific Association for the study of the liver(APASL)[J]. Hepatol Int,2009,3(1):269-282.
    [8] LION IW,LARSON AM. Rele of liver transplantation in acute liver failure[J]. Semin Liver Dis,2008,28(2):201-209.
    [9] MOREAU R. Acute-on-chronic liver failure:A new syndrome in cirrhosis[J]. Clin Mol Hepatol,2016,22(1):1-6.
    [10] FAN HL,YANG PS,CHEN HW,et al. Predictors of the outcomes of acute-on-chronic hepatitis B liver failure[J]. World J Gastroenterol,2012,18(36):5078-5083.
    [11] ZHANG H,JIA L,YAO SW,et al. Value of MELD combined with serum sodium concentration in predicting the short-term outcome of patients with HBV-related acute-on-chronic liver failure in China:A meta-analysis[J]. J Clin Hepatol,2018,34(9):1950-1955.(in Chinese)张辉,贾雷,姚士伟,等.MELD-Na评分对我国HBV相关慢加急性肝衰竭短期预后预测价值的Meta分析[J].临床肝胆病杂志,2018,34(9):1950-1955.
    [12] DUSEJA A,CHOUDHARY NS,GUPTA S,et al. APACHE II score is superior to SOFA,CTP and MELD in predicting the short-term mortality in patients with acute-on-chronic liver failure(ACLF)[J]. J Dig Dis,2013,14(9):484-490.
    [13] LI Q,YUAN GY,TANG KC,et al. Prognostic factors for chronic severe hepatitis and construction of a prognostic model[J].Hepatobiliary Pancreat Dis Int,2008,7(1):40-44.
    [14] WANG JX,CHENG N,XIANG TX,et al. Establishment and evaluation of short-term prognostic model for hepatitis B virus-related acute-on-chronic liver failure[J]. J Clin Hepatol,2019,35(6):1299-1303.(in Chinese)王嘉鑫,程娜,向天新,等.HBV相关慢加急性肝衰竭短期预后模型的建立及评价[J].临床肝胆病杂志,2019,35(6):1299-1303.
    [15] ZIPPRICH A,KUSS O,ROGOWSKI S,et al. Incorporating indocyanin green clearance into the Model for End Stage Liver Disease(MELD-ICG)improves prognostic accuracy in intermediate to advanced cirrhosis[J]. Gut,2010,59(7):963-968.
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