中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 39 Issue 10
Oct.  2023
Turn off MathJax
Article Contents

Value of peripheral blood lymphocyte count in evaluating the short-term prognosis of patients with acute-on-chronic liver failure

DOI: 10.3969/j.issn.1001-5256.2023.10.016
Research funding:

National Natural Science Foundation of China (81971310);

Project of Shaanxi Provincial Clinical Medical Research Center for Infectious Diseases (2020LCZX-01);

Clinical Research Center for Infectious Diseases, the First Affiliated Hospital of Xi’an Jiaotong University (XJTU1AF2021CRF-006);

Clinical Research Center for Infectious Diseases, the First Affiliated Hospital of Xi’an Jiaotong University (2022-XKCRC-04);

Key Research and Development Project of Shaanxi Province (2018ZDXM-SF-037)

More Information
  • Corresponding author: HE Yingli, heyingli2000@xjtu.edu.cn (ORCID: 0000-0001-9444-3678)
  • Received Date: 2023-02-26
  • Published Date: 2023-10-30
  •   Objective  To investigate the influencing factors for the prognosis of patients with acute-on-chronic liver failure (ACLF), and to establish a short-term prognostic model.  Methods  A retrospective analysis was performed for the baseline clinical data of 247 patients with ACLF who were hospitalized in Department of Infectious Diseases, The First Affiliated Hospital of Xi’an Jiaotong University, from January 2011 to December 2016, and the patients were divided into survival group and death group. The two groups were compared to identify the influencing factors for prognosis; a prognostic model was established, and the receiver operating characteristic (ROC) curve was used to assess its predictive efficacy and determine the optimal cut-off value. The independent-samples t test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U rank sum test was used for comparison of non-normally distributed continuous data between groups; the Fisher’s exact test or the Pearson’s chi-square test was used for comparison of categorical data between groups. The univariate and multivariate logistic regression analyses were used to investigate the independent risk factors for 28- and 90-day prognosis, and the Kaplan-Meier method was used to plot the 28-day survival curves.  Results  A total of 220 patients with ACLF were included based on the inclusion and exclusion criteria; there were 148 patients in the 28-day survival group and 72 patients in the 28-day death group, with a 28-day transplantation-free survival rate of 67.27%; there were 115 patients in the 90-day survival group and 105 patients in the 90-day death group, with a 90-day transplantation-free survival rate of 52.27%. The logistic regression analysis showed that female sex (odds ratio [OR]=2.149, P=0.030), high Model for End-Stage Liver Disease (MELD) score (OR=1.120, P<0.001), and low lymphocyte count (OR=0.411, P=0.002) were independent risk factors for 28-day prognosis, and an LS-MELD model for 28-day prognosis was established as Logit (28-day prognosis)=-3.432+0.765×sex-0.890×lymphocyte count×10-9+0.113×MELD(1 for male sex and 2 for female sex). The ROC curve analysis showed that this model had an optimal cut-off value of 0.35, and then the patients were divided into low LS-MELD group (≤0.35) and high LS-MELD group (>0.35); the low LS-MELD group had a significantly higher 28-day survival rate than the high LS-MELD group (P<0.001).  Conclusion  Peripheral blood lymphocyte count combined with sex and MELD score has a certain value in predicting the short-term prognosis of ALCF patients.

     

  • loading
  • [1]
    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.
    [2]
    ARROYO V, ANGELI P, MOREAU R, et al. The systemic inflammation hypothesis: Towards a new paradigm of acute decompensation and multiorgan failure in cirrhosis[J]. J Hepatol, 2021, 74( 3): 670- 685. DOI: 10.1016/j.jhep.2020.11.048.
    [3]
    LI J, LIANG X, JIANG J, et al. PBMC transcriptomics identifies immune-metabolism disorder during the development of HBV-ACLF[J]. Gut, 2022, 71( 1): 163- 175. DOI: 10.1136/gutjnl-2020-323395.
    [4]
    WIESNER R, EDWARDS E, FREEMAN R, et al. Model for end-stage liver disease(MELD) and allocation of donor livers[J]. Gastroenterology, 2003, 124( 1): 91- 96. DOI: 10.1053/gast.2003.50016.
    [5]
    LI JQ, LIANG X, YOU SL, et al. Development and validation of a new prognostic score for hepatitis B virus-related acute-on-chronic liver failure[J]. J Hepatol, 2021, 75( 5): 1104- 1115. DOI: 10.1016/j.jhep.2021.05.026.
    [6]
    CAI JJ, WANG K, HAN T, et al. Evaluation of prognostic values of inflammation-based makers in patients with HBV-related acute-on-chronic liver failure[J]. Medicine, 2018, 97( 46): e13324. DOI: 10.1097/MD.0000000000013324.
    [7]
    GAO FY, SUN L, YE XQ, et al. Development and validation of a prognostic model for acute-on-chronic hepatitis B liver failure[J]. Eur J Gastroenterol Hepatol, 2017, 29( 6): 669- 678. DOI: 10.1097/MEG.0000000000000854.
    [8]
    LEI Q, AO KJ, ZHANG YH, et al. Prognostic factors of the short-term outcomes of patients with hepatitis B virus-associated acute-on-chronic liver failure[J]. Clinics, 2017, 72( 11): 686- 692. DOI: 10.6061/clinics/2017(11)07.
    [9]
    GAO X, ZHAO CJ, HU SH. Short-term prognostic value of age-bilirubin-international normalized ratio-creatinine score in patients with hepatitis B virus-related acute-on-chronic liver failure[J/CD]. Chin J Exp Clin Infect Dis(Electronic Edition), 2022, 16( 2): 108- 114. DOI: 10.3877/cma.j.issn.1674-1358.2022.02.005.

    高祥, 赵成军, 胡世宏. 年龄-胆红素-国际标准化比率-肌酐评分对乙型肝炎相关慢加急性肝功能衰竭患者短期预后的评估价值[J/CD]. 中华实验和临床感染病杂志(电子版), 2022, 16( 2): 108- 114. DOI: 10.3877/cma.j.issn.1674-1358.2022.02.005.
    [10]
    TRIANTAFYLLOU E, WOOLLARD KJ, MCPHAIL MJW, et al. The role of monocytes and macrophages in acute and acute-on-chronic liver failure[J]. Front Immunol, 2018, 9: 2948. DOI: 10.3389/fimmu.2018.02948.
    [11]
    ZHANG DJ, ZHOU B, HOU JL. Research progress in prognostic models of acute-on-chronic liver failure[J]. J Clin Hepatol, 2018, 34( 6): 1351- 1356. DOI: 10.3969/j.issn.1001-5256.2018.06.047.

    张东敬, 周彬, 侯金林. 慢加急性肝衰竭预后模型的研究进展[J]. 临床肝胆病杂志, 2018, 34( 6): 1351- 1356. DOI: 10.3969/j.issn.1001-5256.2018.06.047.
    [12]
    CHEN W, YOU J, CHEN J, et al. Modified model for end-stage liver disease improves short-term prognosis of hepatitis B virus-related acute-on-chronic liver failure[J]. World J Gastroenterol, 2017, 23( 40): 7303- 7309. DOI: 10.3748/wjg.v23.i40.7303.
    [13]
    MONSANTO P, ALMEIDA N, LRIAS C, et al. Evaluation of MELD score and Maddrey discriminant function for mortality prediction in patients with alcoholic hepatitis[J]. Hepato-gastroenterology, 2013, 60( 125): 1089- 1094. DOI: 10.5754/hge11969.
    [14]
    DURAND F, VALLA D. Assessment of the prognosis of cirrhosis: Child-Pugh versus MELD[J]. J Hepatol, 2005, 42 Suppl(1): S100-S 107. DOI: 10.1016/j.jhep.2004.11.015.
    [15]
    ARABI YM, DARA SI, MEMISH Z, et al. Antimicrobial therapeutic determinants of outcomes from septic shock among patients with cirrhosis[J]. Hepatology, 2012, 56( 6): 2305- 2315. DOI: 10.1002/hep.25931.
    [16]
    RUBIN JB, HAMEED B, GOTTFRIED M, et al. Acetaminophen-induced acute liver failure is more common and more severe in women[J]. Clin Gastroenterol Hepatol, 2018, 16( 6): 936- 946. DOI: 10.1016/j.cgh.2017.11.042.
    [17]
    NEPHEW LD, ZIA Z, GHABRIL M, et al. Sex disparities in waitlisting and liver transplant for acute liver failure[J]. JHEP Rep, 2020, 3( 1): 100200. DOI: 10.1016/j.jhepr.2020.100200.
    [18]
    WLODZIMIROW KA, ESLAMI S, ABU-HANNA A, et al. A systematic review on prognostic indicators of acute on chronic liver failure and their predictive value for mortality[J]. Liver Int, 2013, 33( 1): 40- 52. DOI: 10.1111/j.1478-3231.2012.02790.x.
    [19]
    HAN CJ, JIN X, WU ZX, et al. Predicting the prognosis of patients with HBV-related acute liver failure by combining the ratio of neutrophils to lymphocytes and the ratio of C-reactive protein to albumin[J]. Chin J Clin Lab Sci, 2022, 40( 4): 281- 285. DOI: 10.13602/j.cnki.jcls.2022.04.10.

    韩才均, 金星, 吴政燮, 等. 联合中性粒细胞与淋巴细胞比值和C反应蛋白与清蛋白比值预测HBV相关慢加急性肝衰竭患者预后[J]. 临床检验杂志, 2022, 40( 4): 281- 285. DOI: 10.13602/j.cnki.jcls.2022.04.10.
    [20]
    QIANG L, QIN J, SUN CF, et al. Prognostic evaluation of a prediction model based on neutrophil/lymphocyte ratio and red blood cell distribution width of inflammatory factors on hepatitis B virus-related acute-on-chronic liver failure[J]. J Chongqing Med Univ, 2021, 46( 3): 317- 324. DOI: 10.13406/j.cnki.cyxb.002486.

    强丽, 秦娇, 孙长峰, 等. 基于炎症因子中性粒/淋巴细胞比值与红细胞分布宽度的预测模型对乙肝相关慢加急性肝衰竭的预后评估[J]. 重庆医科大学学报, 2021, 46( 3): 317- 324. DOI: 10.13406/j.cnki.cyxb.002486.
    [21]
    CHEN LL, LI Q. Short-term prognostic value of peripheral blood NLR, PCT and MELD score in patients with acute-on-chronic(subacute) liver failure[J]. J Tianjin Med Univ, 2017, 23( 2): 151- 154.

    陈岭岭, 李谦. 外周血NLR、PCT及MELD评分对慢加急(亚急)性肝衰竭近期预后的预测价值[J]. 天津医科大学学报, 2017, 23( 2): 151- 154.
    [22]
    LEITHEAD JA, RAJORIYA N, GUNSON BK, et al. Neutrophil-to-lymphocyte ratio predicts mortality in patients listed for liver transplantation[J]. Liver Int, 2015, 35( 2): 502- 509. DOI: 10.1111/liv.12688.
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(2)  / Tables(3)

    Article Metrics

    Article views (202) PDF downloads(41) Cited by()
    Proportional views
    Related

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return