Validation of prognostic scores for predicting acute liver failure and in-hospital death in patients with dengue-induced severe hepatitis  

作　　者：Tongluk Teerasarntipan Kessarin Thanapirom Roongruedee Chaiteerakij Piyawat Komolmit Sombat Treeprasertsuk 

机构地区：[1]Division of Gastroenterology,Department of Medicine,Faculty of Medicine,Chulalongkorn University and King Chulalongkorn Memorial Hospital,Thai Red Cross Society,Bangkok 10330,Thailand

出　　处：《World Journal of Gastroenterology》2024年第45期4781-4790,共10页世界胃肠病学杂志（英文）

基　　金：Supported by the Fatty Liver Unit,Foundation of the Faculty of Medicine,Chulalongkorn University.

摘　　要：BACKGROUND Acute liver failure(ALF)in dengue is rare but fatal.Early identification of patients who are at risk of ALF is the key strategy to improve survival.AIM To validate prognostic scores for predicting ALF and in-hospital mortality in dengue-induced severe hepatitis(DISH).METHODS We retrospectively reviewed 2532 dengue patients over a period of 16 years(2007-2022).Patients with DISH,defined as transaminases>10 times the normal reference level and DISH with subsequent ALF,were included.Univariate regre-ssion analysis was used to identify factors associated with outcomes.Youden’s index in conjunction with receiver operating characteristic(ROC)analysis was used to determine optimal cut-off values for prognostic scores in predicting ALF and in-hospital death.Area under the ROC(AUROC)curve values were compared using paired data nonparametric ROC curve estimation.RESULTS Of 193 DISH patients,20 developed ALF(0.79%),with a mortality rate of 60.0%.International normalized ratio,bilirubin,albumin,and creatinine were indepen-dent predictors associated with ALF and death.Prognostic scores showed excel-lent performance:Model for end-stage liver disease(MELD)score≥15 predicted ALF(AUROC 0.917,sensitivity 90.0%,specificity 88.4%)and≥18 predicted death(AUROC 0.823,sensitivity 86.9%,specificity 89.1%);easy albumin-bilirubin(ALBI)score≥-30 predicted ALF and death(ALF:AUROC 0.835,sensitivity80.0%,specificity 72.2%;death:AUROC 0.808,sensitivity 76.9%,specificity 69.3%);ALBI score≥-2 predicted ALF and death(ALF:AUROC 0.806,sensitivity 80.0%,specificity 77.4%;death:AUROC 0.799,sensitivity 76.9%,specificity 74.3%).Platelet-ALBI score also showed good performance in predicting ALF and death(AUROC=0.786 and 0.699,respectively).MELD and EZ-ALBI scores had similar performance in predicting ALF(Z=1.688,P=0.091)and death(Z=0.322,P=0.747).CONCLUSION MELD score is the best predictor of ALF and death in DISH patients.EZ-ALBI score,a simpler yet effective score,shows promise as an alternative prognostic tool in dengue patients.

关 键 词：FULMINANT Clinical outcomes Liver injury Prognostic assessment Predictive models Mortality prediction 

分 类 号：R512.8[医药卫生—内科学]