Value Of PTAR、MELD Score And ICG Clearance In Evaluating The Prognosis Of Patients With Decompensated Cirrhosis

Objective:To explore the clinical value of the international standardized ratio of prothrombin to albumin ratio(PTAR),MELD score and ICG(indocyanine green)clearance test ICGR15 value in evaluating the prognosis of patients with decompensated cirrhosis.Methods:This study included 172 patients with decompensated liver cirrhosis admitted to the Department of Gastroenterology,the Second Affiliated Hospital of Kunming Medical University from April 2016 to April 2017.Using a retrospective cohort study method,all patients were followed up until death,liver transplantation,loss to follow-up or follow-up for 2 years,until the study termination date(April 2019).Collect demographic data of patients,including gender,age,primary liver disease,comorbidities(varices,varicose rupture hemorrhage,hepatic encephalopathy,ascites,bacterial infection,hepatorenal syndrome)and other medical history,Laboratory biochemical indicators:albumin(ALB),alanine aminotransferase(ALT),glutamyltransferase(GGT),aspartate aminotransferase(AST),alkaline phosphatase(ALP),total Bilirubin(TBil),Creatinine(Scr),Total Cholesterol(TCHOL),Blood Sodium(Na),Prothrombin Time(PT),Prothrombin International Normalized Ratio(INR),White Blood Cells(WBC),Hemoglobin(Hb)),neutrophil count,PTAR,ICGR15,MELD score,etc.With death as the endpoint event,the included patients were divided into survival group(n=98)and death group(n=74)according to the disease outcome during the 2-year follow-up.Analyze the relevant factors affecting the prognosis,and evaluate the predictive value of PTAR for the prognosis of patients with decompensated liver cirrhosis.The measurement data in accordance with normal distribution are expressed as mean±standard deviation(x±s).T-test was used to compare the continuous data of normal distribution between the two groups;The measurement data of non-normal distribution were expressed by median and quartile interval[M(P25-P75)].Mann-Whitney U test was used for comparison between the two groups,and x2 test was used for comparison of counting data between the two groups.The relevant variables were analyzed by Cox univariate analysis,and then the variables with statistically significant results were included in the Cox multi-factor risk ratio model to analyze the independent influencing factors.Draw the working characteristic curve of the subjects(ROC),calculate the area(AUC),under the ROC curve,and determine the best truncation value(cut-off value)according to the specificity and sensitivity of the ROC curve.Finally,Kaplan-Meier survival curve was used to analyze the 2-year survival rate of patients with different PTAR,MELD and ICGR15,and log-rank test was used to compare the differences between groups.Results:1.A total of 172 patients with decompensated cirrhosis were included,including 124 males(72.1%)and 48 females(28.0%),with an average age of(52.36±13.10).The main causes of patients entering the decompensated stage of cirrhosis are hepatitis B cirrhosis(77 cases,44.8%),hepatitis C cirrhosis(3 cases,1.7%),and alcoholic cirrhosis(35 cases,20.3%)),primary biliary cirrhosis(34 cases,19.8%),drug-induced hepatitis cirrhosis(6 cases,3.5%),non-alcoholic fatty liver cirrhosis(1 case,0.6%),cryptogenic liver cirrhosis(16 cases,9.3%).74 cases(43.0%)died within 2 years of follow-up,58 males and 16 females,with an average of(54.81±13.64)years;98 cases survived(57.0%),66 males and 32 females,with an average of(50.51±12.44)years.Compared with the survival group,the PTAR,ICGR15 and(MELD)score of the model of end-stage liver disease in the death group were significantly higher than those in the survival group(Z=-7.823,t=3.458,t=5.921,all P<0.001).2.The optimal cut-off values of PTAR、ICG and MELD score in predicting 2 years prognosis were 0.05、41.00 and 37.25,respectively,with AUCs of 0.849、0.651 and 0.724,respectively;the combination of PTAR、ICG and MELD score only had an increased AUC of 0.851,and the accuracy of using PTAR alone is still very high.(95%CI:0.791-0.906,Sensitivity:0.797,Specificity:0.786)3.Survival analysis showed that the survival rate of patients with high level PTAR(PTAR≥0 05)was significantly lower than that of patients with low level PTAR(PTAR<0 05)(x2=60.07,P<0.000).Multivariate Cox regression analysis showed that PTAR≥0.05was an independent risk factor for 2-year death.Conclusions:1.PTAR score,MELD score and ICGR15 can all predict the prognosis of patients with decompensated liver cirrhosis.PTAR score is the best,The area under the curve is as high as 0.849,followed by MELD score and ICGR15.2.The higher the PTAR score,the worse the prognosis.PTAR≥0.05could be used as an independent predictor of 2-year death in patients with decompensated liver cirrhosis.The risk of death in patients with PTAR≥0.05was 2.564 times higher than that in patients with PTAR<0.05.However,at present,there are still few relevant research reports at home and abroad,which need to be further demonstrated by a randomized controlled study with a large sample size.3.The unique advantage of laboratory-based PTAR score is simple,objective and convenient.For patients with decompensated liver cirrhosis,it is convenient and effective to evaluate their prognosis and intervene as soon as possible to improve their quality of life.4.The main cause of patients entering the decompensated stage of liver cirrhosis is hepatitis B cirrhosis.