The Establishment Of A Predictive Model Of HRS In Patients With Decompensated Liver Cirrhosis And The Influence Of Traditional Chinese Medicine On Its Prognosis

Hepatorenal syndrome(HRS)is a special common type of renal failure,usually a serious complication in patients with severe liver disease such as acute liver failure,cirrhosis with ascites,and alcoholic h epatitis.Mainly with renal dysfunction such as progressive oliguria or anuria,azotemia,and dilute hyponatremia.Once HRS occurs,its prognosis is poor and mortality is high.Therefore,it is clinically possible to identify high-risk groups with HRS early,and early intervention is extremely important to reduce mortality and improve patient prognosis.Currently,HRS cannot be predicted.A simple and easy scoring model that takes place.Whether anti-fibrotic proprietary Chinese medicine has an effect on the prognosis of patients with HRS is unknown.OBJECTIVES1.To explore the influencing factors of hepatorenal syndrome in patients with decompensated cirrhosis within 2 years,and to establish a predictive model.2.To explore the effect of anti-fibrotic Chinese medicine treatment on the prognosis of patients with decompensated liver cirrhosis complicated with HRS.METHODS1.A retrospective collection of 1562 hospitalized patients with decompensated cirrhosis from August 2008 to August 2016 in Beijing Ditan Hospital affiliated to Capital Medical University.The patients were followed up for 2 years.The COX risk-ratio regression model was used to analyze the independent influencing factors of hepatorenal syndrome within 2 years.The final score of HRS in patients with decompensated cirrhosis was established within 2 years,model.2.Retrospectively collected 190 inpatients with decompensated cirrhosis and HRS from Beijing Ditan Hospital affiliated to Capital Medical University from August 2008 to August 2016.According to the application of traditional Chinese medicine,118 cases of non-Chinese medicine cohort and Chinese medicine were divided.72 cases in the queue.The prognosis of patients in the two treatment cohorts was compared within 2 years.RESULTS1.COX single factor and multivariate analysis were performed on 1562 patients with decompensated cirrhosis.The final results showed:spontaneous peritonitis(SBP),hepatic encephalopathy(HE),age,serum sodium(Na+),seru m.Creatinine(Cr),serum uric acid(URCA),total bilirubin(TBIL),and international normalized value(INR)were independent influencing factors of HRS in patients with decompensated cirrhosis within 2 years(P<0.05).The meaningful continuous factor variables Age,Na+,TBIL,Cr,URCA,and INR are converted into categorical variables according to their respective cut-off values,and then COX multivariate analysis is performed to finally determine the occurrence of decompensated cirrhosis patients for 2 years.Eight independent influencing factors related to HRS and establish a scoring model:SBP(yes=1 point,no=0 point),HE(yes=2 point,no=0 point),Age<55 is 0 point,Age)55 is 2,Na+≥137mmol/L is 0,Na+<137mmol/L is 2,TBIL<50umol/L is 0,TBIL ≥ 50umol is 3;Cr<70umol/L is 0,Cr ≥ 70umol/L is 2,URCA<330umol/L is 0,URCA≥330umol/L is 2;INR<1.5 is 0,and INR≥1.5 is 2.The scoring model has a score range of 0-16.The scoring model predicts that the area under the ROC curve of 2 years of HRS in patients with decompensated cirrhosis is 0.787,which is higher than the area under the ROC curve and the area under the curve of CTP and MELD.The best cut-off value for this model score is 5.5.According to the cut-off value,patients are divided into low-risk group with HRS within 2 years(predicted score 0-6),high-risk group(predicted score 7-16)There was a significant difference in the incidence of HRS between the two groups(7.0%vs.34.6%,log-rank P<0.001).The scoring model also showed statistically significant differences in HRS predictions between patients with decompensated cirrhosis of different causes within 2 years(CHB:log-rank P<0.001,ALD:log rank P<0.001).And the predictive value in patients with CTPA+B,C also had a statistically significant difference(CTPA+B:log-rank P<0.001,Child-Pugh C:log-rank P<0.001).2.One-way and multi-factor analysis of COX risk ratio model in 190 patients with decompensated cirrhosis with HRS.Traditional Chinese medicine treatment was an independent protective factor for death in HRS patients within 2 years(HR=0.590,95%CI=0.381-0.913,P=0.018);combined anti-fibrotic Chinese medicine treatment can significantly reduce the mortality within 2 years of cirrhosis with HRS(76.9%vs.41.5%,log-rank P=0.001);in any CTP group,the application of traditional Chinese medicine is less than the application of traditional Chinese medicine The mortality of patients was significantly reduced,CTP-B(46.7%vs 71.8%,log-rank P=0.0305),CTP-C(36.4%vs.81.8%,log-rank P<0.001),in CTP-B and The statistical effect of CTP-C Chinese medicine treatment on mortality of HRS patients showed statistical difference.In different pathogens,it was found that for patients with HRS with CHB and ALD,combined Chinese medicine treatment can reduce the risk of death within 2 years,which are CHB(22.6%vs 78.6%,P=0.007)and ALD(43.8%vs.72.0%,P=0.033).Comparing the effect of traditional Chinese medicine treatment on the survival time of patients with HRS,it was found that the average survival time of patients who died in the Chinese medicine cohort was 511 days,and the median survival time of non-Chinese medicine cohort was 248 days,and there was a statistically significant difference between the two(P<0.001).CONCLUSIONS1.SBP,HE,baseline Age,Na+,TBIL,UREA,Cr,and INR were independent influencing factors of HRS in patients with decompensated cirrhosis within 2 years(P<0.05).The predictive model established on this basis can well identify patients with high-risk decompensated cirrhosis who have concurrent HRS within 2 years.Moreover,this predictive model is suitable for patients with decompensated cirrhosis due to CHB,ALD and CTP.2.This study found that patients with decompensated cirrhosis with HRS(including CTP-B,C and disease because of CHB,ALD),patients with anti-fibrotic proprietary Chinese medicine have lower mortality,anti-fibrotic Chinese patent medicine The use may be associated with decreased mortality in patients with decompensated cirrhosis and HRS;anti-fibrotic Chinese medicine may be associated with prolonged survival in patients with cirrhosis with HRS.Further prospective studies are needed to confirm the protective effect of Chinese medicine on the prognosis of patients with hepatorenal syndrome.