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ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 39 Issue 3
Mar.  2023
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Article Contents

Value of total bilirubin rebound rate and total bilirubin clearance rate in evaluating the prognosis of severe drug-induced liver injury after artificial liver support therapy

DOI: 10.3969/j.issn.1001-5256.2023.03.018
Research funding:

Tianjin Key Medical Discipline(Specialty)Construction Project (TJYXZDXK-034A);

Tianjin Health Project (TJWJ2022XK029);

Beijing iGandan Foundation (RGGJJ-2021-014)

More Information
  • Corresponding author: XIANG huiling, huilingxiang@163.com (ORCID: 0000-0003-3678-4225)
  • Received Date: 2022-08-10
  • Accepted Date: 2022-10-29
  • Published Date: 2023-03-20
  •   Objective  To investigate the value of total bilirubin rebound rate (TBRR), total bilirubin clearance rate (TBCR), and TBCR after 1 week of treatment (ΔTBCR) in evaluating the short-term prognosis of patients with severe drug-induced liver injury (DILI) after artificial liver support therapy.  Methods  A retrospective analysis was performed for 203 patients with severe DILI who received artificial liver support therapy in Tianjin Third Central Hospital from September 2013 to December 2021, and general information, biochemical parameters, and clinical classification were collected. The patients were divided into improved group and unhealed group according to the prognosis at discharge, and Model for End-Stage Liver Disease (MELD) score, TBRR, TBCR, and ΔTBCR were calculated. The independent samples 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. The receiver operating characteristic (ROC) curve was plotted to investigate the value of assessment indices in predicting the prognosis of patients, and the Kaplan-Meier method was used to investigate the difference in the length of hospital stay in the context of different assessment indices.  Results  Compared with the unhealed group, the improved group had significantly lower age (t=-2.762, P < 0.05), white blood cell count (Z=-3.184, P < 0.05), total bilirubin (t=-2.809, P < 0.05), conjugated bilirubin (t=-2.739, P < 0.05), international normalized ratio (Z=-2.357, P < 0.05), MELD score (t=-3.090, P < 0.05), and TBRR (t=-4.749, P < 0.05), as well as significantly higher albumin (t=2.198, P < 0.05), prothrombin time activity (t=2.018, P < 0.05), TBCR (t=2.166, P < 0.05), and ΔTBCR (t=9.549, P < 0.05). MELD score, TBRR, TBCR, and ΔTBCR had an area under the ROC curve (AUC) of 0.656, 0.727, 0.611, and 0.879, respectively, and ΔTBCR had a better predictive value than TBRR (Z=3.169, P=0.001 5). The optimal cut-off value was 22.5% for TBRR (with a sensitivity of 94.6% and a specificity of 45.2%) and 27.4% for ΔTBCR (with a sensitivity of 77.7% and a specificity of 86.5%). ΔTBCR showed a good predictive value in different clinicopathological types, with extremely high sensitivity (91.4%) and specificity (100.0%) in evaluating the treatment outcome of patients with mixed-type DILI after artificial liver support therapy.  Conclusion  TBRR and ΔTBCR have a higher value than MELD score in evaluating the short-term prognosis of patients with severe DILI after artificial liver support therapy, among which ΔTBCR has a higher predictive value.

     

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  • [1]
    DEVARBHAVI H, AITHAL G, TREEPRASERTSUK S, et al. Drug-induced liver injury: Asia Pacific Association of Study of Liver consensus guidelines[J]. Hepatol Int, 2021, 15(2): 258-282. DOI: 10.1007/s12072-021-10144-3.
    [2]
    Drug-induced Liver Disease Study Group, Chinese Society of Hepatology, Chinese Medical Association. Guidelines for the management of drug-induced liver injury[J]. J Clin Hepatol, 2015, 31(11): 1752-1769. DOI: 10.3969/j.issn.1001-5256.2015.11.002.

    中华医学会肝病学分会药物性肝病学组. 药物性肝损伤诊治指南[J]. 临床肝胆病杂志, 2015, 31(11): 1752-1769. DOI: 10.3969/j.issn.1001-5256.2015.11.002.
    [3]
    Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases. Guideline for nonbioartificial 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.
    [4]
    Severe Liver Disease and Artificial Liver Group, Chinese Society of Hepatology, Chinese Medical Association. Expert consensus on clinical application of artificial liver and blood purification (2022 edition)[J]. J Clin Hepatol, 2022, 38(4): 767-775. DOI: 10.3969/j.issn.1001-5256.2022.04.007.

    中华医学会肝病学分会重型肝病与人工肝学组. 人工肝血液净化技术临床应用专家共识(2022年版)[J]. 临床肝胆病杂志, 2022, 38(4): 767-775 DOI: 10.3969/j.issn.1001-5256.2022.04.007.
    [5]
    SHAKIL AO, KRAMER D, MAZARIEGOS GV, et al. Acute liver failure: clinical features, outcome analysis, and applicability of prognostic criteria[J]. Liver Transpl, 2000, 6(2): 163-169. DOI: 10.1002/lt.500060218.
    [6]
    SILBERHUMER GR, HETZ H, RASOUL-ROCKENSCHAUB S, et al. Is MELD score sufficient to predict not only death on waiting list, but also post-transplant survival?[J]. Transpl Int, 2006, 19(4): 275-281. DOI: 10.1111/j.1432-2277.2006.00250.x.
    [7]
    WANG ZC, SHAO JG, GU EL. Short term prediction of rebound rate of total bilirubin in patients with chronic 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.
    [8]
    XIN KF, LI M, LI SS, et al. The role of TBARR, TBRR and TBCR in evaluating the prognosis of patients with chronic acute 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.
    [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]
    CHALASANI NP, MADDUR H, RUSSO MW, et al. ACG clinical guideline: diagnosis and management of idiosyncratic drug-induced liver injury[J]. Am J Gastroenterol, 2021, 116(5): 878-898. DOI: 10.14309/ajg. 0000000000001259.
    [11]
    FORMAN LM, LUCEY MR. Predicting the prognosis of chronic liver disease: an evolution from child to MELD. Mayo end-stage liver disease[J]. Hepatology, 2001, 33(2): 473-475. DOI: 10.1053/jhep.2001.22481.
    [12]
    CHEN M, SUZUKI A, BORLAK J, et al. Drug-induced liver injury: Interactions between drug properties and host factors[J]. J Hepatol, 2015, 63(2): 503-514. DOI: 10.1016/j.jhep.2015.04.016.
    [13]
    TIAN B, LI F, DENG BC. Clinical effect of artificial liver support system in treatment of drug-induced liver failure: A meta-analysis [J]. J Clin Hepatol, 2020, 36(4): 823-828. DOI: 10.3969/j.issn.1001-5256.2020.04.023.

    田冰, 李范, 邓宝成. 人工肝支持系统治疗药物性肝衰竭临床效果的Meta分析[J]. 临床肝胆病杂志, 2020, 36(4): 823-828. DOI: 10.3969/j.issn. 1001-5256.2020.04.023.
    [14]
    ZHU SH, GUO CC, LIU ZG, et al. Efficacy of abiotic artificial liver in the treatment of severe drug-induced liver injury[J]. Chin Hepatol, 2020, 25(1): 78-81. DOI: 10.14000/j.cnki.issn.1008-1704.2020.01.029.

    朱绍华, 郭长存, 刘志国, 等. 非生物型人工肝治疗重症药物性肝损伤疗效观察[J]. 肝脏, 2020, 25(1): 78-81. DOI: 10.14000/j.cnki.issn.1008-1704.2020.01.029.
    [15]
    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.
    [16]
    MORALES-ARRÁEZ D, VENTURA-COTS M, ALTAMIRANO J, et al. The MELD score is superior to the maddrey discriminant function score to predict short-term mortality in alcohol-associated hepatitis: A global study[J]. Am J Gastroenterol, 2022, 117(2): 301-310. DOI: 10.14309/ajg.0000000000001596.
    [17]
    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.
    [18]
    ZHANG YF, YU WY, CHEN DL, et al. The prognosis of acute (subacute) hepatic failure with hepatic encephalopathy treated with artificial liver[J/CD]. Prac J Organ Transplant, 2020, 8(4): 252-255. DOI: 10.3969/j.issn.2095-5332.2020.04.004.

    张叶凡, 于万有, 陈冬玲, 等. 人工肝治疗急(亚急)性肝衰竭合并肝性脑病的中短期预后评估[J/CD]. 实用器官移植电子杂志, 2020, 8(4): 252-255. DOI: 10.3969/j.issn.2095-5332.2020.04.004.
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