METHODS: Patients with rodenticidal hepatotoxicity from 2014 to 2023 managed in our department were included in this study. Kochi criteria (model for end-stage liver disease [MELD] score ≥ 36 or international normalized ratio [INR] ≥ 6 with hepatic encephalopathy [HE]) derived specifically for rodenticidal hepatotoxicity (PubMed IDentifier [PMID]: 26310868) were used to assess need for liver transplantation. We analyzed predictors of survival at one month. ∆Bilirubin, ∆MELD score and ∆INR were calculated as percentage change of the parameter after third PLEX session (or after last PLEX if < 3 PLEX sessions done) from baseline pre-PLEX value.
RESULTS: Of 200 patients with rodenticidal hepatotoxicity, 114 patients were treated with low-volume PLEX (PLEX-LV). No patient had liver transplantation. Of 78 patients who fulfilled Kochi criteria, 32 patients were PLEX-LV eligible and underwent PLEX-LV (M: 10; age: 20.5, 7-70 years; median, range; acute liver failure: 24). Twenty-two (69%; acute liver failure: 14) of the 32 patients were alive at one month. Presence of HE (p = 0.03) and ∆MELD (p < 0.001) were significant predictors on univariate analysis, while ∆MELD (aOR = 0.88, 95% CI: 0.79-0.98, p = 0.01) was the only significant independent predictor of one-month transplant-free survival. Area under receiver operating characteristic (ROC) for ∆MELD was 0.93 (95% CI:0.85-1.00) and a decrease of ≥ 20% in MELD score while on PLEX-LV had 90% sensitivity and 90% specificity in predicting one-month survival.
CONCLUSIONS: Decline in MELD while on PLEX-LV independently predicted one-month transplant-free survival in rodenticidal hepatotoxicity patients. This may help guide decision on stopping PLEX-LV in patients predicted to respond to treatment and to consider alternate treatment options in non-responders.
方法:本研究纳入了2014年至2023年在我们部门管理的灭鼠性肝毒性患者。Kochi标准(终末期肝病模型[MELD]评分≥36或国际标准化比率[INR]≥6伴肝性脑病[HE])专门针对灭鼠性肝毒性(PubMedIDentifier[PMID]:26310868)用于评估肝移植的需要。我们分析了一个月生存率的预测因素。Δ胆红素,在第3次PLEX治疗后(或在第3次PLEX治疗后,如果<3次PLEX治疗,则在最后一次PLEX治疗后)计算参数相对于基线PLEX前值的百分比变化。
结果:在200例灭鼠性肝毒性患者中,114例患者接受低容量PLEX(PLEX-LV)治疗。没有患者进行肝移植。在符合高知标准的78名患者中,32例患者符合PLEX-LV标准,并接受了PLEX-LV(M:10;年龄:20.5,7-70岁;中位数,范围;急性肝功能衰竭:24)。32例患者中有22例(69%;急性肝功能衰竭:14)在一个月时还活着。HE(p=0.03)和ΔMELD(p<0.001)的存在是单变量分析的重要预测因子,而ΔMELD(aOR=0.88,95%CI:0.79-0.98,p=0.01)是一个月无移植生存的唯一有意义的独立预测因子。ΔMELD的受试者工作特征下面积(ROC)为0.93(95%CI:0.85-1.00),MELD评分降低≥20%,而PLEX-LV在预测一个月生存率方面具有90%的敏感性和90%的特异性。
结论:使用PLEX-LV时MELD下降独立预测了杀虫性肝毒性患者一个月的无移植生存率。这可能有助于指导预测对治疗有反应的患者停止PLEX-LV的决定,并在无反应者中考虑替代治疗方案。