外周血淋巴细胞计数在慢加急性肝衰竭短期预后评估中的价值

Objective To investigate the influencing factors for the prognosis of patients with acute－on－chronic liver failure （ACLF），and to establish a short－term prognostic model. Methods A retrospective analysis was performed for the baseline clinical data of 247 patients with ACLF who were hospitalized in Department of Infectious Diseases，The First Affiliated Hospital of Xi’an Jiaotong University，from January 2011 to December 2016，and the patients were divided into survival group and death group. The two groups were compared to identify the influencing factors for prognosis；a prognostic model was established，and the receiver operating characteristic（ROC）curve was used to assess its predictive efficacy and determine the optimal cut－off value. The independent－samples t test was used for comparison of normally distributed continuous data between groups，and the Mann－Whitney U rank sum test was used for comparison of non－normally distributed continuous data between groups；the Fisher’s exact test or the Pearson’s chi－square test was used for comparison of categorical data between groups. The univariate and multivariate logistic regression analyses were used to investigate the independent risk factors for 28－ and 90－day prognosis，and the Kaplan－Meier method was used to plot the 28－day survival curves. Results A total of 220 patients with ACLF were included based on the inclusion and exclusion criteria；there were 148 patients in the 28－day survival group and 72 patients in the 28－day death group，with a 28－day transplantation－free survival rate of 67.27%；there were 115 patients in the 90－day survival group and 105 patients in the 90－day death group，with a 90－day transplantation－free survival rate of 52.27%. The logistic regression analysis showed that female sex（odds ratio［OR］=2.149，P=0.030），high Model for End－Stage Liver Disease（MELD）score （OR=1.120，P<0.001），and low lymphocyte count （OR=0.411，P=0.002） were independent risk factors for 28－day prognosis，and an LS－MELD model for 28－day prognosis was established as Logit（28－day prognosis）=－3.432+0.765× sex－0.890×lymphocyte count×10^－9+0.113×MELD（1 for male sex and 2 for female sex）. The ROC curve analysis showed that this model had an optimal cut－off value of 0.35，and then the patients were divided into low LS－MELD group（≤0.35）and high LS－MELD group（>0.35）；the low LS－MELD group had a significantly higher 28－day survival rate than the high LS－MELD group（P<0.001）. Conclusion Peripheral blood lymphocyte count combined with sex and MELD score has a certain value in predicting the short－term prognosis of ALCF patients.