背景:加权甲状腺激素在灾难性ACLF中的预后价值。
方法:本研究纳入了一个回顾性队列(n=635)和两个前瞻性队列(n=353和198)。从可靠性方面评估了新开发的预后评分的性能,歧视,和临床净收益。
结果:促甲状腺激素(TSH)被确定为甲状腺激素中HBV-ACLF的最潜在预后预测因子。新的评分(mCLIF-OFs)是用CLIF-OFs中的加权TSH和其他评分器官使用回顾性队列(n=635)得出的。预测的风险和观察到的死亡概率在mCLIF-OF的分位数之间具有可比性(Hosmer-Lemeshowχ2=4.28,p=0.83;Brier缩放=11.9)。mCLIF-OFs30天死亡率的C指数(0.885[0.883-0.887])显著高于CLIF-OFs,CLIF-SOFA,CLIF-CACLFs,MELD,和Child-Pugh(所有p<0.001)。mCLIF-OF的预测错误率与上述五个得分相比绝对改善为19.0%至61.1%。经过概率密度函数(PDF)的分析,在上述预后评分中,mCLIF-OF的重叠系数最小(27.9%).此外,mCLIF-OFs在广泛的死亡风险阈值范围内也显示出比5项以上预后评分更大的净获益.类似的结果在两个前瞻性ACLF队列与HBV和非HBV病因验证。
结论:加权TSH预示了ACLF患者的预后,可视为下丘脑-垂体-甲状腺轴的“受损器官”。新型mCLIF-OFs是一种可靠的预后评分,具有比CLIF-OFs更好的辨别能力和临床净获益,CLIF-SOFA,CLIF-CACLFs,MELD,还有Child-Pugh.本文受版权保护。保留所有权利。
OBJECTIVE: To weight the prognostic value of thyroid hormones in catastrophic acute-on-chronic liver failure (ACLF).
METHODS: A retrospective cohort (n = 635) and two prospective cohorts (n = 353, and 198) were enrolled in this study. The performance of a novel developed prognostic score was assessed from aspects of reliability, discrimination, and clinical net benefit.
RESULTS: Thyroid-stimulating hormone (TSH) was identified to have the most potential as a prognostic predictor for hepatitis B virus-related ACLF among thyroid hormones. The novel score (modified chronic liver failure-organ failure score [mCLIF-OFs]) was developed with weighted TSH and other scored organs in the CLIF-OFs using the retrospective cohort (n = 635). The predicted risk and observed probabilities of death were comparable across the deciles of mCLIF-OFs (Hosmer-Lemeshow χ2 = 4.28, p = 0.83; Brier scaled = 11.9). The C-index of mCLIF-OFs (0.885 [0.883-0.887]) for 30-day mortality was significantly higher than that of the CLIF-OFs, chronic liver failure-sequential organ failure assessment score (CLIF-SOFAs), CLIF-C ACLFs, Model of End-stage Liver Disease (MELD), and Child-Pugh (all p < 0.001). The absolute improvements of prediction error rates of the mCLIF-OFs compared to the above five scores were from 19.0% to 61.1%. After the analysis of probability density function, the mCLIF-OFs showed the least overlapping coefficients (27.9%) among the above prognostic scores. Additionally, the mCLIF-OFs showed greater net benefit than the above five prognostic scores over a wide range of risk threshold of death. Similar results were validated in two prospective ACLF cohorts with HBV and non-HBV etiologies.
CONCLUSIONS: Weighted TSH portended the outcome of ACLF patients, which could be treated as a \"damaged organ\" of the hypothalamic-pituitary-thyroid axis. The novel mCLIF-OFs is a reliable prognostic score with better discrimination power and clinical net benefit than CLIF-OFs, CLIF-SOFAs, CLIF-C ACLFs, MELD, and Child-Pugh.