Establishment Of Death Risk Model For Patients With Hepatorenal Syndrome In End-stage Liver Disease And Relationship Between TCM Syndromes And Laboratory Indexes

Objective1.Through clinical statistical analysis,the risk factors of short-term death in patients with end-stage hepatorenal syndrome were obtained,and the predictive scoring model was established.2.Objective to explore the relationship between TCM syndromes related to hepatorenal syndrome and laboratory indexes through statistical analysis.Methods1.104 inpatients with hepatorenal syndrome diagnosed in the Affiliated Hospital of Chengdu University of traditional Chinese medicine from May 2012 to March2020 were retrospectively collected.Patients who met the inclusion criteria were followed up for 30 days from diagnosis until the end point(death).cox proportional regression model was used to analyze the baseline data of all patients.The independent risk factors of death in patients with hepatorenal syndrome within 30 days were obtained.Based on these factors,the predictive risk model of death in patients with end-stage liver disease within 30 days was established.2.The data of 104 patients with hepatorenal syndrome were collected and classified according to the TCM syndrome classification standard.Objective to investigate the relationship between TCM syndromes and laboratory indexes in patients with hepatorenal syndrome by statistical analysis of TCM syndromes and laboratory indexes.Results1.Univariate Cox regression analysis showed that: serum creatinine(Scr),urea nitrogen(BUN),direct bilirubin(TBIL),indirect bilirubin(DBIL),Cystatin-C(CysC),neutrophil lymphocyte ratio(NLR),white blood cell(WBC),percentage of neutrophils(N%),prothrombin time(PT),international normalized ratio(INR),prothrombin activity(PTA),Spontaneous bacterial peritonitis(SBP)and hepatocellular carcinoma(HCC)were risk factors for death in patients with hepatorenal syndrome(P < 0.05).Multivariate Cox regression analysis showed that international normalized ratio(INR),prothrombin time(PT),percentage of neutrophils(N%),serum creatinine(Scr)and primary liver cancer(HCC)were independent risk factors for death in patients with hepatorenal syndrome within 30days(P < 0.05).Finally,INR,HCC,N% and SCR were included in the risk prediction model of death within 30 days of hepatorenal syndrome,specifically HCC(yes,1 point,no,0point),INR(≥ 2.2,1 point,< 2.2,0 point),Scr(≥ 187.5μmol/L,0 point)μ Mol / l was1 point,< 187.5 μmol/L was 0 point),N(≥ 79.9% was 1 point,and < 79.9% was 0point);The score range of the prediction model is 0-4.The AUC of the scoring model was 0.894,which was higher than that of INR,HCC,N%,Scr,CTP and MELD.According to the cut-off value,the patients were divided into low-risk group(predictive score 0-1)and high-risk group(predictive score 2-4)with 30 day death.There was significant difference in the incidence of death within 30 days between the two groups(log rank P < 0.001).2.According to the statistical analysis of TCM Syndrome Types and laboratory data of 104 patients with hepatorenal syndrome,6 TCM syndrome types were involved,among which 38 cases(36.5%)were damp heat syndrome,23 cases(22.1%)were blood stasis syndrome,16 cases(15.45%)were qi stagnation syndrome,11 cases(10.6%)were liver kidney yin deficiency syndrome,10 cases(9.6%)were spleen kidney yang deficiency syndrome,and 6 cases(5.8%)were spleen deficiency syndrome.The levels of Scr and Cys-C were higher in patients with blood stasis syndrome,ALT,AST,TBIL and DBIL were higher in patients with damp heat syndrome,and the levels of Scr,Cys-C,ALT,AST,TBIL and DBIL were lower in patients with spleen kidney yang deficiency syndrome(P < 0.05).Conclusion1.International normalized ratio(INR),primary liver cancer(HCC),serum creatinine(Scr),percentage of neutrophils(N%)and prothrombin time(PT)were independent influencing factors of death in patients with hepatorenal syndrome within30 days(P < 0.05).The model can identify the high-risk patients with hepatorenal syndrome who died within 30 days.2.This study involved six syndrome types of damp heat syndrome,blood stasis syndrome,qi stagnation syndrome,liver and kidney yin deficiency syndrome,spleen and kidney yang deficiency syndrome and spleen deficiency syndrome.Patients with blood stasis syndrome had higher levels of Scr and Cys-C,patients with damp heat syndrome had higher levels of ALT,AST,TBIL and DBIL,while patients with spleen and kidney yang deficiency syndrome had lower levels of Scr,Cys-C,ALT,AST,TBIL and DBIL(P < 0.05).It can provide a certain basis for clinical dialectical classification of traditional Chinese medicine.