Establishment Of A Model For Predicting The Risk Of Death In Decompensated Stage Of Hepatitis B Cirrhosis

Research purposes:To establish a model for predicting the risk of death in the decompensated stage of hepatitis B cirrhosis,and compare it with the MELD score and the Child-Pugh score.Method:A total of 591 patients with decompensated hepatitis B and liver cirrhosis who attended the Sino-Japanese Union Hospital of Jilin University from January 2015 to January 2020 were collected.Other causes of liver disease,such as liver cancer and hepatitis C virus(hepatitis C virus)were excluded.,HCV),alcoholic liver disease,autoimmune liver disease or other malignant tumors,etc.,retrospective analysis.According to the ALT level,they were divided into group A: ALT level ≥5×ULN group(225 cases),group B: 2×ULN≤ALT<5×ULN(173 cases),group C: ALT level<2×ULN group(193 cases).Collect the clinical data of multiple hospitalizations and outpatient visits,including gender,age,ALT,AFP,TBIL,PT,albumin,creatinine,PLT,NLR,HBV-DNA,HBe Ag,HBe Ab,QHBs Ag,anti-HCV antibody and anti-HDV antibody,Abdominal imaging examination,MELD score,Child-Pugh grading.During the treatment of all patients,in addition to the conventional supportive treatment,NAs treatment.The collected data will be sorted out and then statistically analyzed.Rresult:1.Group A is significantly higher than the B and C groups: PT,TBIL,PLT,HBs Ag quantitative,MELD score,Child-Pugh classification;A group is significantly lower than the other two groups: HBe Ag,splenomegaly,ascites,Varicose veins of the esophagus.The index of group C that was significantly higher than that of groups A and B was HBV-DNA quantification(P2=0.001,P3=0.001).The negative conversion rate of HBV-DNA in group C was significantly lower than that in group A(p=0.001).There were differences in NLR among the three groups,and the numerical values were group A,group B,and group C from low to high.2.After 1 year of follow-up,compared with the baseline value: the MELD score and Child-Pugh classification of group A patients were 3.59±5.70 and 9.60±2.16,respectively,which were significantly lower than the baseline value of 9.26±7.26(P< 0.001),10.78 ±2.03(P<0.001);The MELD score of group C patients was significantly lower than the baseline value(6.17±6.39 vs.2.82±5.41,P=0.045).The indicators of group A patients were significantly lower than those of groups B and C:splenomegaly,ascites,esophageal varices,HBV-DNA quantification,and Child Pugh score;significantly higher than those of groups B and C.The indicators of groups B and C were HBV-DNA negative conversion rate.3.With death as the clinical outcome,591 patients were followed up.The median follow-up time was 514 days,the longest follow-up time was 1817 days,and the shortest follow-up time was 1 day.Starting from the third month,the mortality of group A patients was obvious Lower than the other two groups;the mortality rate of patients in groups B and C was significantly increased.4.Univariate and multivariate analysis of the mortality of CHB patients in decompensated stage: PT,NLR,TBIL,albumin,creatinine,baseline ALT≥5×ULN are independent factors that affect the mortality of patients.Based on this,the Cox regression equation is established: Cox(Y)=0.338 ×(TBIL)+0.067 ×(PT)+0.024 ×(NLR)+0.377×(creatinine)-0.069×(albumin)-0.829×(ALT≥5× ULN,is 1 if yes,0 if not).5.Compare the established Cox regression equation with MELD score and Child-Pugh classification by ROC curve analysis: the area under the ROC curve(AUC)is 0.817(95% confidence interval 0.784-0.851),0.751(95% confidence interval)0.712-0.790),0.728(95% confidence interval 0.687-0.769),the comparison of the three is statistically significant(P<0.001).The highest sensitivity for predicting the death of patients with decompensated hepatitis B cirrhosis is the Cox regression equation(value 81.4%);the highest specificity is the MELD score(value 76.9%),and the lowest is the Cox regression equation(The value is 64.4%);the highest Youden index is the Cox regression equation(the value is 45.8%),and the lowest is the Child-Pugh classification(the value is 37.3%).In conclusion:1.For CHB-LC decompensated patients treated with NAs,patients with baseline ALT≥5×ULN have a better prognosis than patients with ALT<5×ULN.2.PT,NLR,TBIL,albumin,creatinine,baseline ALT≥5×ULN are independent risk factors that affect the mortality of patients.3.In our current research,the established Cox regression model is better than MELD score and Child-Pugh classification(AUC are 0.817,0.751,0.728,P>0.001)...