Predictive value of PTAAR for short-term prognosis of patients with hepatitis B virus-related acuteon-chronic liver failure

doi:10.3877/cma.j.issn.2095-3232.2024042

Abstract

Abstract:

Objective

To evaluate the predictive value of prothrombin activity-to-albumin ratio（PTAAR） for the short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure （ACLF）.

Methods

Clinical data of 286 ACLF patients admitted to the Third Affiliated Hospital of Sun Yat-sen University from 2019 to 2020 were retrospectively analyzed. The local ethical committee approval was received. Among them，243 patients were male and 43 female，aged 19-75 years，with a median age of 46 years. The patients received 3-month follow-up. All patients were divided into the survival group（n=238） and death group （n=48）. General data，biochemical parameters and coagulation function of patients were collected. The influencing factors of clinical prognosis of ACLF patients were screened by Logistic regression analysis. ACLF prediction model was constructed based on PTAAR. The predictive value of PTAAR model was evaluated by using the receiver operating characteristic （ROC） curve.

Results

The 3-month mortality rate of ACLF patients was 16.8%（48/286）. Multivariate Logistic regression analysis showed that age，total bilirubin （TB） and PTAAR were the independent factors affecting the short-term prognosis of ACLF patients （OR=1.058，1.003，0.212； P＜0.05）. The prediction model for short-term prognosis of ACLF patients was established based on PTAAR: Logit （P）=-4.365+0.077×Age+0.003×TB-1.813×PTAAR. The area under the ROC curve （AUC） of PTAAR model was 0.782 （95%CI: 0.711-0.853），significantly larger than 0.671 （95%CI: 0.583-0.758） of MELD score （Z=2.381， P＜0.05）. The cutoff values of the model based on PTAAR and MELD score were 0.133 and 22.886，and 0.854 and 0.792 for the sensitivity，and 0.601 and 0.529 for the specificity，respectively.

Conclusions

The 3-month mortality rate of patients with hepatitis B-related ACLF is relatively high. PTAAR is a predictor for the 3-month prognosis of patients with ACLF. The prediction model based on PTAAR can achieve higher prediction performance.

Key words: Liver failure, Prothrombin activity to albumin ratio （PTAAR）, Model for endstage liver disease （MELD）, Prognosis

Xiaoling Guan, Wenying Zhou, Hongping Chen. Predictive value of PTAAR for short-term prognosis of patients with hepatitis B virus-related acuteon-chronic liver failure[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(06): 841-845.

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URL: https://zhgzwkssxdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-3232.2024042

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Figures/Tables 3

组别	例数	性别［例（%）］		年龄［岁，M（Q₁，Q₃）］	AST［U/L，M（Q₁，Q₃）］	ALT［U/L，M（Q₁，Q₃）］	ALB（g/L， $\overset{ˉ}{x}$ ±s）
组别	例数	女	男	年龄［岁，M（Q₁，Q₃）］	AST［U/L，M（Q₁，Q₃）］	ALT［U/L，M（Q₁，Q₃）］	ALB（g/L， $\overset{ˉ}{x}$ ±s）
生存组	238	38（16）	200（84）	45（35，53）	192（100，520）	382（84，911）	35±5
死亡组	48	5（10）	43（90）	51（44，58）	242（110，656）	374（84，1 087）	35±6
统计值		χ ²=0.963		Z=-3.701	Z=-1.271	Z=0.543	t=-0.299
P值		0.380		＜0.001	0.204	0.587	0.765
组别	例数	TB［μmol/L，M（Q₁，Q₃）］	CHE［U/L，M（Q₁，Q₃）］	Scr［μmol/L，M（Q₁，Q₃）］	PTAAR M（Q₁，Q₃）	FIB［g/L，M（Q₁，Q₃）］
生存组	238	308（206，384）	3 853（2 905，4 988）	66（56，78）	1.1（0.8，1.4）	1.6（1.3，1.9）
死亡组	48	337（262，443）	3 704（2 644，5 112）	61（56，83）	0.8（0.6，1.1）	1.5（1.2，1.7）
统计值		Z=-2.682	Z=0.217	Z=0.429	Z=3.949	Z=1.262
P值		0.007	0.828	0.668	＜0.001	0.207

组别	例数	性别［例（%）］		年龄［岁，M（Q₁，Q₃）］	AST［U/L，M（Q₁，Q₃）］	ALT［U/L，M（Q₁，Q₃）］	ALB（g/L， $\overset{ˉ}{x}$ ±s）
组别	例数	女	男	年龄［岁，M（Q₁，Q₃）］	AST［U/L，M（Q₁，Q₃）］	ALT［U/L，M（Q₁，Q₃）］	ALB（g/L， $\overset{ˉ}{x}$ ±s）
生存组	238	38（16）	200（84）	45（35，53）	192（100，520）	382（84，911）	35±5
死亡组	48	5（10）	43（90）	51（44，58）	242（110，656）	374（84，1 087）	35±6
统计值		χ ²=0.963		Z=-3.701	Z=-1.271	Z=0.543	t=-0.299
P值		0.380		＜0.001	0.204	0.587	0.765
组别	例数	TB［μmol/L，M（Q₁，Q₃）］	CHE［U/L，M（Q₁，Q₃）］	Scr［μmol/L，M（Q₁，Q₃）］	PTAAR M（Q₁，Q₃）	FIB［g/L，M（Q₁，Q₃）］
生存组	238	308（206，384）	3 853（2 905，4 988）	66（56，78）	1.1（0.8，1.4）	1.6（1.3，1.9）
死亡组	48	337（262，443）	3 704（2 644，5 112）	61（56，83）	0.8（0.6，1.1）	1.5（1.2，1.7）
统计值		Z=-2.682	Z=0.217	Z=0.429	Z=3.949	Z=1.262
P值		0.007	0.828	0.668	＜0.001	0.207

变量	单因素分析		多因素分析
变量	OR（95%CI）	P值	OR（95%CI）	P值
年龄	1.058（1.027～1.089）	＜0.001	1.082（1.047～1.119）	＜0.001
性别男	1.634（0.608～4.393）	0.330
AST	1.001（1.000～1.001）	0.039	1.001（1.000～1.001）	0.558
ALT	1.001（1.000～1.001）	0.198
ALB	0.991（0.937～1.049）	0.764
TB	1.003（1.001～1.006）	0.004	1.003（1.001～1.006）	0.013
CHE	1.000（1.000～1.000）	0.808
Scr	1.000（0.995～1.005）	0.980
PTAAR	0.212（0.088～0.513）	＜0.001	0.206（0.076～0.560）	0.002
FIB	0.701（0.399～1.232）	0.217

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