基于MELD评分分层分析人工肝治疗对平台期肝衰竭患者短期预后的影响

目的对平台期肝衰竭患者进行MELD评分分层后,研究人工肝治疗对其短期(28 d及90 d内)病死率的影响。方法回顾性纳入2015年1月-2019年4月南方医科大学南方医院收治的肝衰竭患者187例,其中人工肝组73例,非人工肝组114例。按平台期不同的MELD评分分层分析2组间28 d、90 d病死率的差异,存活者的住院费用和住院日的差异,以及人工肝不良反应发生率。计量资料2组间比较采用t检验,计数资料2组间比较采用χ^2检验或Fisher确切概率法。结果人工肝治疗可显著降低MELD评分30~39分人工肝组(5.9%)vs非人工肝组(39.6%),P<0.001]及40分人工肝组(25.0%)vs非人工肝组(72.7%),P<0.05]的平台期肝衰竭患者28 d病死率。人工肝治疗可降低MELD评分30~39分平台期肝衰竭患者90 d病死率人工肝组(23.5%)vs非人工肝组(62.3%),P<0.001]。人工肝治疗不能明显缩短存活患者的平均住院时间(P>0.05);人工肝治疗对90 d内存活患者的住院总费用无明显影响(P>0.05);人工肝相关不良反应的发生率为29.1%,但症状轻微,经对症治疗后缓解。结论平台期肝衰竭MELD评分<30分,28 d及90 d内病死率均较低,可根据患者经济条件和意愿,给予合理选择人工肝治疗;平台期肝衰竭MELD评分30~39分,若无明显禁忌证,则积极建议行人工肝治疗;平台期肝衰竭MELD评分40分,若无明显禁忌证,28 d内建议积极行人工肝治疗,同时建议尽早肝移植。人工肝对90 d内存活患者的住院总费用、平均住院日均无明显影响,不增加患者经济负担。

Effect of artificial liver support therapy on the short-term prognosis of patients with liver failure in the plateau stage:A stratified analysis based on Model for End-Stage Liver Disease score

Objective To investigate the effect of artificial liver support therapy on the short-term(28-and 90-day)mortality rate of patients with liver failure in the plateau stage through a stratified analysis based on Model for End-Stage Liver Disease(MELD)score.Methods A retrospective analysis was performed for 187 patients with liver failure who were admitted to Nanfang Hospital,Southern Medical University,from January 2015 to April 2019,with 73 patients in the artificial liver group and 114 in the non-artificial liver group.The stratified analysis based on MELD score in the plateau stage was performed to investigate the differences in 28-and 90-day mortality rates,hospital costs and length of hospital stay of surviving patients,and incidence rate of adverse reactions of artificial liver support therapy between the two groups.The t-test was used for comparison of continuous data between the two groups,and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between the two groups.Results Compared with the non-artificial liver group,the artificial liver group had a significant reduction in the 28-day mortality rate of the patients with an MELD score of 30-39(5.9%vs 39.6%,P<0.001)or those with an MELD score of 40(25.0%vs 72.7%,P<0.05).Compared with the non-artificial liver group,the artificial liver group had a significant reduction in the 90-day mortality rate of the patients with an MELD score of 30-39(23.5%vs 62.3%,P<0.001).Artificial liver support therapy did not significantly shorten the mean hospital stay of the surviving patients(P>0.05)and had no significant influence on the total hospital costs of the surviving patients within 90 days(P>0.05).The incidence rate of adverse reactions related to artificial liver support therapy was 29.1%,but the symptoms were mild and were relieved after symptomatic treatment.Conclusion Patients with an MELD score of<30 in the plateau stage tend to have low 28-and 90-day mortality rates,and artificial liver support therapy can be reasonably selected according to the patient’s economic conditions and willingness.Artificial liver support therapy is recommended for patients with an MELD score of 30-39 in the plateau stage if there is no obvious contraindication.For patients with an MELD score of 40 in the plateau stage,artificial liver support therapy is recommended within 28 days if there is no obvious contraindication,and liver transplantation is recommended as soon as possible.Artificial liver support therapy has no significant influence on the total hospital costs and mean hospital stay of the surviving patients within 90 days and does not increase the economic burden of patients.