The Value Of ICG Clearance,MELD And MELD-Na Scores In Evaluating The Short-term Prognosis Of Patients With Liver Failure Treated With Artificial Liver Support System

Objective:To explore the clinical application value of ICG(inoculation cyanide green)clearance test(ICGR15)value and MELD score and MELD-Na score in end-stage liver disease model in patients with liver failure.Methods:90 patients with liver failure treated with artificial liver were routinely performed liver and kidney function,international normalized ratio(INR)of prothrombin time and prothrombin time,and MELD and MELD-Na scores after serum Na test.ICGR15 clearance test.The patients were followed up for the prognosis of artificial liver treatment.The ICGR15 value,MELD and MELD-Na scores of the improved group and the recombinant group were compared.The Spearman rank correlation test was used to evaluate the correlation between the two,and the receiver operating characteristic curve ROC was applied.The area under the curve was evaluated for the near-term prediction value of ICGR15 value,MELD,and MELD-Na score.Results:1.After artificial liver treatment,52(57.8%)patients improved.The ICGR15,MELD,and MELD-Na scores before treatment were 37.00±10.13,17.89±4.69,18.85±5.36,and 38(42.2%)patients were aggravated or died.The preoperative ICGR15,MELD,and MELD-Na scores were 43.78±8.44,22.38±4.15,and 26.60±7.23,respectively.The difference between the two groups was statistically significant(P<0.05).2.The ROC curve showed that the area under the curve(AUC)of the ICGR15,MELD score,MELD-Na score,ICGR15 combined with MELD score,ICGR15 combined with MELD-Na score,MELD combined with MELD-Na score in the assessment of the patient’s short-term prognosis were 0.731(95%).Confidence interval CIO.620-0.842),0.755(95%confidence interval CI0.657-0.854),0.802(95%confidence interval CI0.714-0.891),0.803(95%confidence interval CI0.724-0.898)),0.844(95%confidence interval CI0.754-0.921),0.803(95%confidence interval CIO.724-0.898),P values of the three groups were<0.01,the difference was statistically significant.Using the normality Z test,there was no significant difference between the three groups,P 0.05(ICGR15 and MELD Z=0.320,P=0.375;ICGR15 and MELD-Na Z=0.988,P=0.838;MELD and MELD-Na)Z=0.700,P=0.758).3.The short-term prognosis of the patients was analyzed.The cutoff values of ICGR15,MELD and MELD-Na scores were 40.25(sensitivity:78.4%,specificity:78.8%,accuracy:51.3%),respectively,when the best curve Youden index was the highest in the ROC curve.21.10(sensitivity:65.8%,specificity:73.1%,accuracy:38.9%),21.15(sensitivity:81.6%,specificity:67.3%,accuracy:48.9%).When ICGR15<40.25,the patient’s aggravation or mortality after artificial liver treatment was 22.6%(12/53).When ICGR15 40.25,the patient’s aggravation or mortality after artificial liver treatment was 70.3%(26/37).The difference in mortality between the two groups was very significant(χ2=20.262,P<0.001).When MELD<21.10,the patient’s aggravation or mortality after artificial liver treatment was 25.5%(13/51).When MELD was 21.10,the patient’s aggravation or mortality after artificial liver treatment was 64.1%(25/39).The difference in mortality between the two groups was very significant(x2=13.507,P<0.001).When MELD-Na<21.15,the patient’s aggravation or mortality after artificial liver treatment was 16.7%(7/42).When MELD-Na 21.15,the patient’s aggravation or mortality after artificial liver treatment was 64.6%.(31/48),the difference in mortality between the two groups was very significant(χ2=21.082,P<0.001).4.Correlation coefficients were calculated using nonparametric correlation analysis.ICGR15 and MELD:correlation coefficient r=0.236,P=0.025;ICGR15 and MELD-Na:correlation coefficient r=0.301,P=0.004;MELD and MELD-Na:correlation coefficient r=0.844,P<0.001.Conclusions:1.ICGR15,MELD score and MELD-Na score can predict the short-term prognosis of artificial liver treatment in patients with liver failure.The MELD-Na score is the best,followed by ICGR15.2.1f patients with liver failure have ICGR15≥40.25,MELD≥21.10,and MELD-Na score≥21.15 before artificial liver treatment,patients with artificial liver treatment have poor curative effect,and the disease is aggravated and the risk of death is high3.ICGR15 combined with MELD-Na score can better predict the short-term prognosis of artificial liver treatment in patients with liver failure.