Abstract:
Objective To analyze the prognostic nutritional index (PNI) combined with immunoglobulin,fasting blood glucose (FPG) and serum alpha-fetoprotein (AFP) in predicting poor prognosis of patients with HBV associated chronic acute liver failure (HBV-ACLF) after treatment.
Methods
A total of 220 patients with HBV-ACLF admitted to Qingdao Municipal Hospital from October 2020 to October 2023 were included. According to the prognosis after treatment,the patients were respectively included in the good prognosis group (n=118) and the poor prognosis group (n=102),and patients with poor prognosis were divided into survival group (n=68) and death group (n=34) according to whether they died or not. The indexes of PNI,immunoglobulin (IgG,IgM,IgA),FPG and AFP were compared among patients in different groups at admission. Logistic multivariate regression analysis and receiver operating characteristic curve (ROC) were used to calculate the value of these indexes in predicting the poor prognosis of patients with HBV-ACLF after treatment.
Results
Among 220 patients,102 patients had poor prognosis (46.36%),and 34 patients died (15.45%). Age,immunoglobulin IgG,IgA,IgM,AFP PNI and blood glucose of patients in the good prognosis group were higher than those in the poor prognosis group,and FPG was lower than that in the poor prognosis group. Comparison between the death group and the survival group in the poor prognosis group was made,age,immunoglobulin IgG,IgA,IgM,AFP,PNI and blood glucose in the death group were higher than those in the survival group,and FPG was lower than that in the survival group (P<0.05). Logistic multivariate regression analysis showed that Stage Ⅲ and Ⅳ of hepatic encephalopathy,immunoglobulin IgG≥17 g/L,IgA≥3.8 g/L,IgM≥2.5 g/L,FPG<6.2 mmol/L,AFP≥80 mmol/L and PNI≥35 were all risk factors for poor prognosis in patients with HBV-ACLF (P<0.05). Combined with hepatic encephalopathy Ⅲ and Ⅳ,IgG,IgA,IgM,PNI,FPG and AFP,the AUC of patients with poor prognosis was 0.856,and the sensitivity and specificity were 85.89%and 87.69% (P<0.05).
Conclusion
The prognosis of patients with HBV-ACLF is closely correlated with PNI,IgG,IgM,IgA,FPG and AFP,and the combined monitoring of these factors is helpful to provide a more reliable reference for prognosis prediction.
Key words:
Chronic acute liver failure,
Hepatitis B virus,
Prognostic nutritional index,
Immunoglobulin,
Fasting blood glucose level,
Alpha-fetoprotein
Jia Dong, Kun Wang, Li Zhang. Prognostic nutritional index combined with immunoglobulin,fasting blood glucose level and serum alpha-fetoprotein in predicting poor prognosis in patients with HBV associated chronic acute liver failure after treatment[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2024, 14(06): 555-559.