背景:肝硬化背景下顽固性腹水患者通常面临不良预后。经颈静脉肝内门体分流术(TIPS)是一种有效的干预措施,但缺乏可靠的术后预后评估工具。以前使用的临床生化标志物,如血清白蛋白浓度(Alb),钠(Na+)浓度,和血清肌酐(Scr),预测价值有限。因此,对小说的追求,评估肝硬化和难治性腹水患者TIPS后预后的特异性生物标志物具有重要的实际意义.
目的:为了调查Child-Pugh评分之间的关联,终末期肝病模型(MELD)评分,肝硬化顽固性腹水患者血清胱抑素C(CysC)水平与TIPS后预后的关系。
方法:对2019年8月至2021年8月在我院接受TIPS治疗的75例肝硬化和难治性腹水患者进行回顾性分析。这些患者定期随访两年,死亡人数被精心记录。根据患者的预后状况,将患者分为存活组(n=45例)或死亡组(n=30例)。收集两组患者的临床资料,计算Child-Pugh评分和MELD评分进行分析。采用Spearman相关分析评价Child-Pugh分级与预后的相关性,MELD得分,CysC级。此外,利用Cox比例风险模型进行多因素分析,以确定影响肝硬化和难治性腹水患者TIPS后预后的独立危险因素.受试者工作特征曲线(ROC)确定了CysC浓度的预测值,Child-Pugh年级,和MELD评分对TIPS后肝硬化伴顽固性腹水患者预后的影响。
结果:在2年的随访期间,在接受TIPS治疗的75例肝硬化和顽固性腹水患者中,30例(40.00%)患者死亡。死者群体表现出天冬氨酸转氨酶升高,丙氨酸氨基转移酶,总胆红素,Scr,凝血酶原时间,CysC,国际标准化比率,Child-Pugh,和MELD评分与生存队列相比,死亡组Alb和Na+水平降低(P<0.05)。Spearman分析显示,预后与Child-Pugh评分之间存在中度至高度正相关,MELD得分,CysC水平(r=0.709、0.749、0.671,P<0.05)。使用Cox比例风险模型的多因素分析表明,肝硬化和难治性腹水患者TIPS后预后的独立危险因素是CysC(HR=3.802;95CI:1.313-11.015),Child-Pugh(HR=3.030;95CI:1.858-4.943),和MELD(HR=1.222;95CI:1.073-1.393)评分。ROC分析证实,与Child-Pugh和MELD评分的经典预后模型相比,CysC对肝硬化和顽固性腹水患者TIPS后预后的预测准确性略低.该分析产生的灵敏度和特异性值分别为83.33%和82.22%,分别。该时刻的曲线下面积值为0.883,最佳截止值为1.95mg/L。
结论:监测血清CysC浓度对于评估肝硬化和顽固性腹水患者TIPS后的预后具有重要价值。基于血清CysC水平的预测模型,与Scr水平相反,更有利于评估肝硬化腹水患者的病情和预后。
BACKGROUND: Individuals with refractory ascites in the context of liver cirrhosis typically face an adverse prognosis. The transjugular intrahepatic portosystemic shunt (TIPS) is an efficacious intervention, but there is a lack of reliable tools for postoperative prognosis assessment. Previously utilized clinical biochemical markers, such as the serum albumin concentration (Alb), sodium (Na+) concentration, and serum creatinine (Scr), have limited predictive value. Therefore, the quest for novel, specific biomarkers to evaluate the post-TIPS prognosis in patients with liver cirrhosis and refractory ascites holds significant practical importance.
OBJECTIVE: To investigate the associations between the Child-Pugh score, model for end-stage liver disease (MELD) score, and serum cystatin C (Cys C) level and post-TIPS prognosis in patients with liver cirrhosis and refractory ascites.
METHODS: A retrospective analysis was conducted on 75 patients with liver cirrhosis and refractory ascites who underwent TIPS at our institution from August 2019 to August 2021. These patients were followed up regularly for two years, and the death toll was meticulously documented. The patients were allocated into a survival group (n = 45 patients) or a deceased group (n = 30 patients) based on their prognosis status. The clinical data of the two groups were collected, and Child-Pugh scores and MELD scores were calculated for analysis. Spearman correlation analysis was carried out to evaluate the correlation of prognosis with Child-Pugh grade, MELD score, and Cys C level. Additionally, a multiple-factor analysis utilizing the Cox proportional hazard model was used to identify independent risk factors affecting the post-TIPS prognosis of patients with liver cirrhosis and refractory ascites. The receiver operating characteristic curve (ROC) ascertained the predictive value of the Cys C concentration, Child-Pugh grade, and MELD score for the prognosis of liver cirrhosis with refractory ascites in post-TIPS patients.
RESULTS: During a 2-year follow-up period, among 75 patients with liver cirrhosis and refractory ascites who underwent TIPS treatment, 30 patients (40.00%) passed away. The deceased cohort exhibited heightened aspartate aminotransferase, alanine aminotransferase, total bilirubin, Scr, prothrombin time, Cys C, international normalized ratio, Child-Pugh, and MELD scores compared to those of the survival cohort, while Alb and Na+ levels were attenuated in the deceased group (P < 0.05). Spearman analysis revealed moderate to high positive correlations between prognosis and Child-Pugh score, MELD score, and Cys C level (r = 0.709, 0.749, 0.671, P < 0.05). Multivariate analysis using the Cox proportional hazard model demonstrated that the independent risk factors for post-TIPS prognosis in patients with liver cirrhosis and refractory ascites were Cys C (HR = 3.802; 95%CI: 1.313-11.015), Child-Pugh (HR = 3.030; 95%CI: 1.858-4.943), and MELD (HR = 1.222; 95%CI: 1.073-1.393) scores. ROC analysis confirmed that, compared to those of the classic prognostic models for Child-Pugh and MELD scores, the predictive accuracy of Cys C for post-TIPS prognosis in patients with liver cirrhosis and refractory ascites was slightly lower. This analysis yielded sensitivity and specificity values of 83.33% and 82.22%, respectively. The area under the curve value at this juncture was 0.883, with an optimal cutoff value set at 1.95 mg/L.
CONCLUSIONS: Monitoring the serum Cys C concentration is valuable for assessing the post-TIPS prognosis in patients with liver cirrhosis and refractory ascites. Predictive models based on serum Cys C levels, as opposed to Scr levels, are more beneficial for evaluating the condition and prognosis of patients with ascites due to cirrhosis.