中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 39 Issue 11
Nov.  2023
Turn off MathJax
Article Contents

Value of albumin-related ratios in predicting the risk of death in patients with hepatitis B virus-related acute-on-chronic liver failure

DOI: 10.3969/j.issn.1001-5256.2023.11.011
More Information
  • Corresponding author: SHENG Yunjiang, sheng200410@163.com (ORCID: 0000-0003-0772-5971)
  • Received Date: 2023-02-27
  • Accepted Date: 2023-03-29
  • Published Date: 2023-11-28
  •   Objective  To investigate and compare the value of albumin-related ratios [total bilirubin-to-albumin ratio (TAR), creatinine-to-albumin ratio (CAR), prothrombin time-international normalized ratio-to-albumin ratio (IAR), neutrophil count-to-albumin ratio (NAR), and red blood cell distribution width-to-albumin ratio (RAR)] in predicting the short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF).  Methods  A retrospective analysis was performed for 354 patients with HBV-ACLF who were admitted to Department of Infectious Diseases, The Affiliated Hospital of Southwest Medical University, from June 2017 to February 2022, and according to their prognosis at 3 months of follow-up, they were divided into survival group (n=272) and death group (n=82). Related indices were recorded for all patients, including age, sex, complications, and the results of routine blood test, liver function, and coagulation for the first time after admission, and albumin-related ratios and Model for End-Stage Liver Disease (MELD) score were calculated. 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 distribution continuous data between groups; the chi-square test was used for comparison of categorical data between groups. The Spearman correlation test was used to investigate the correlation between albumin-related ratios and MELD score. The Logistic regression analysis was used to explore the association of MELD score, TAR, CAR, IAR, NAR, and RAR with poor prognosis. The area under the ROC curve (AUC) was used to as sess the accuracy of albumin-related ratios and MELD score in predicting the short-term prognosis of HBV-ACLF patients, and the De-Long test was used for the comparison of AUC.  Results  Compared with the death group, the survival group had significantly lower MELD score (Z=-8.071, P<0.001), TAR (Z=-6.695, P<0.001), CAR (Z=-4.463, P<0.001), IAR (Z=-7.912, P<0.001), NAR (Z=-4.061, P<0.001), and RAR (Z=-4.788, P<0.001). MELD score was positively correlated with CAR (r=0.616, P<0.001), IAR (r=0.733, P<0.001), TAR (r=0.657, P<0.001), NAR (r=0.392, P<0.001), and RAR (r=0.380, P<0.001). The multivariate regression analysis of MELD score and albumin-related ratios showed that high TAR (odds ratio [OR]=1.014, 95% confidence interval [CI]: 1.008 — 1.020, P<0.001) and high IAR (OR=22.052, 95%CI: 6.937 — 70.103, P<0.001) were independent risk factors for death. The ROC curves were plotted for albumin-related ratios and MELD score to evaluate their discriminatory ability for mortality, and the results showed that MELD score, TAR, CAR, IAR, NAR, and RAR had an AUC of 0.794, 0.744, 0.663, 0.788, 0.648, and 0.674, respectively, among which MELD score had the highest sensitivity of 86.59% and CAR had the highest specificity of 77.57%. TAR combined with IAR had an AUC of 0.809, with a sensitivity of 76.8% and a specificity of 71.3%. Subgroup analysis of HBV-ACLF showed that TAR combined with IAR had the highest AUC values of 0.884 and 0.733, respectively, in patients with type A or type C HBV-ACLF.  Conclusion  TAR and IAR can be used as simple and effective prognostic tools to predict the 90-day mortality of HBV-ACLF patients.

     

  • loading
  • [1]
    MOREAU R, GAO B, PAPP M, et al. Acute-on-chronic liver failure: A distinct clinical syndrome[J]. J Hepatol, 2021, 75( Suppl 1): S27- S35. DOI: 10.1016/j.jhep.2020.11.047.
    [2]
    SARIN SK, KEDARISETTY CK, ABBAS Z, et al. Acute-on-chronic liver failure: Consensus recommendations of the Asian Pacific Association for the Study of the Liver(APASL) 2014[J]. Hepatol Int, 2014, 8( 4): 453- 471. DOI: 10.1007/s12072-014-9580-2.
    [3]
    ZHAO RH, SHI Y, ZHAO H, et al. Acute-on-chronic liver failure in chronic hepatitis B: An update[J]. Expert Rev Gastroenterol Hepatol, 2018, 12( 4): 341- 350. DOI: 10.1080/17474124.2018.1426459.
    [4]
    KARVELLAS CJ, FRANCOZ C, WEISS E. Liver transplantation in acute-on-chronic liver failure[J]. Transplantation, 2021, 105( 7): 1471- 1481. DOI: 10.1097/TP.0000000000003550.
    [5]
    LI H, ZHENG J, CHEN LA, et al. The scoring systems in predicting short-term outcomes in patients with hepatitis B virus-related acute-on-chronic liver failure[J]. Ann Palliat Med, 2020, 9( 5): 3048- 3058. DOI: 10.21037/apm-20-608.
    [6]
    QUINLAN GJ, MARTIN GS, EVANS TW. Albumin: Biochemical properties and therapeutic potential[J]. Hepatology, 2005, 41( 6): 1211- 1219. DOI: 10.1002/hep.20720.
    [7]
    BERNARDI M, RICCI CS, ZACCHERINI G. Role of human albumin in the management of complications of liver cirrhosis[J]. J Clin Exp Hepatol, 2014, 4( 4): 302- 311. DOI: 10.1016/j.jceh.2014.08.007.
    [8]
    ARROYO V, CLÀRIA J. Acute-on-chronic liver failure, human serum albumin, and immune modulation: The beginning of an exciting adventure[J]. Clin Gastroenterol Hepatol, 2018, 16( 5): 633- 636. DOI: 10.1016/j.cgh.2017.12.008.
    [9]
    HAN Z, HE X, PENG SQ. Neutrophil count to albumin ratio as a prognostic indicator for HBV-associated decompensated cirrhosis[J]. J Clin Lab Anal, 2021, 35( 4): e23730. DOI: 10.1002/jcla.23730.
    [10]
    CHOI JS, CHUNG KS, LEE EH, et al. The role of bilirubin to albumin ratio as a predictor for mortality in critically ill patients without existing liver or biliary tract disease[J]. Acute Crit Care, 2020, 35( 1): 24- 30. DOI: 10.4266/acc.2019.00738.
    [11]
    LU CD, LONG JY, LIU HY, et al. Red blood cell distribution width-to-albumin ratio is associated with all-cause mortality in cancer patients[J]. J Clin Lab Anal, 2022, 36( 5): e24423. DOI: 10.1002/jcla.24423.
    [12]
    NI QW, WANG X, WANG J, et al. The red blood cell distribution width-albumin ratio: A promising predictor of mortality in heart failure patients-A cohort study[J]. Clin Chim Acta, 2022, 527: 38- 46. DOI: 10.1016/j.cca.2021.12.027.
    [13]
    YıLMAZ MF, KARAGÖZ A, ZEREN G, et al. Relationship between in-hospital mortality and creatinine/albumin in patients with ST-elevation myocardial infarction without standard modifiable risk factors[J]. Biomark Med, 2022, 16( 14): 1043- 1053. DOI: 10.2217/bmm-2022-0241.
    [14]
    ÜLGER Y, DELIK A. Prognostic value of international normalized ratio-to-albumin ratio and ferritin level in chronic liver patients with hepatocellular carcinoma[J]. J Gastrointest Cancer, 2022, 53( 4): 1028- 1033. DOI: 10.1007/s12029-021-00738-3.
    [15]
    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.
    [16]
    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.
    [17]
    CLÀRIA J, STAUBER RE, COENRAAD MJ, et al. Systemic inflammation in decompensated cirrhosis: Characterization and role in acute-on-chronic liver failure[J]. Hepatology, 2016, 64( 4): 1249- 1264. DOI: 10.1002/hep.28740.
    [18]
    WANG J, HUANG R, YAN XM, et al. Red blood cell distribution width: A promising index for evaluating the severity and long-term prognosis of hepatitis B virus-related diseases[J]. Dig Liver Dis, 2020, 52( 4): 440- 446. DOI: 10.1016/j.dld.2019.12.144.
    [19]
    QIN J, QIANG L, CHEN W, et al. Red blood cell distribution width is a independent prognostic indicator for mortality in patients with HBV related acute-on-chronic liver failure[J]. J South Med Univ, 2018, 38( 11): 1354- 1359. DOI: 10.12122/j.issn.1673-4254.2018.11.13.

    秦娇, 强丽, 陈文, 等. 红细胞分布宽度可作为乙型肝炎相关慢加急性肝衰竭患者短期死亡的独立预测因子[J]. 南方医科大学学报, 2018, 38( 11): 1354- 1359. DOI: 10.12122/j.issn.1673-4254.2018.11.13.
    [20]
    RUI CR, LEVADA-PIRES AC, SILVA EBD, et al. The critical role of cell metabolism for essential neutrophil functions[J]. Cell Physiol Biochem, 2020, 54( 4): 629- 647. DOI: 10.33594/000000245.
    [21]
    SIMBRUNNER B, TRAUNER M, REIBERGER T, et al. Recent advances in the understanding and management of hepatorenal syndrome[J]. Fac Rev, 2021, 10: 48. DOI: 10.12703/r/10-48.
    [22]
    CHEN MJ, LI X, TANG SH. Progress of multidimensional evaluation of liver function in prognosis of patients with liver failure[J]. Clin J Med Offic, 2023, 51( 9): 901- 903, 907. DOI: 10.16680/j.1671-3826.2023.09.05.

    陈美娟, 李雪, 汤善宏. 多维度评估肝功能在肝衰竭患者预后中研究进展[J]. 临床军医杂志, 2023, 51( 9): 901- 903, 907. DOI: 10.16680/j.1671-3826.2023.09.05.
    [23]
    GAO F, CAI MX, LIN MT, et al. Prognostic value of international normalized ratio to albumin ratio among critically ill patients with cirrhosis[J]. Eur J Gastroenterol Hepatol, 2019, 31( 7): 824- 831. DOI: 10.1097/MEG.0000000000001339.
    [24]
    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.
    [25]
    PIERRAKOS C, VELISSARIS D, FELLEITER P, et al. Increased mortality in critically ill patients with mild or moderate hyperbilirubinemia[J]. J Crit Care, 2017, 40: 31- 35. DOI: 10.1016/j.jcrc.2017.01.017.
    [26]
    LAI M, WANG X, YAO QW, et al. Predictive value of the initial MELD score and its derivative scores for early survival rate after liver transplantation in patients with liver failure[J]. Ogran Transplant, 2022, 13( 4): 489- 494. DOI: 10.3969/j.issn.1674-7445.2022.04.012.

    赖曼, 王鑫, 姚勤伟, 等. 术后首次MELD评分及其衍生评分对肝衰竭患者肝移植术后早期生存率的预测价值[J]. 器官移植, 2022, 13( 4): 489- 494. DOI: 10.3969/j.issn.1674-7445.2022.04.012.
  • 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(5)

    Article Metrics

    Article views (133) PDF downloads(32) Cited by()
    Proportional views
    Related

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return