BACKGROUND The diagnosis of bacterial infection is difficult in patients with acute-on-chronic liver failure(ACLF).AIM To evaluate the diagnostic accuracy of widely used parameters for bacterial infection in ACLF and ...BACKGROUND The diagnosis of bacterial infection is difficult in patients with acute-on-chronic liver failure(ACLF).AIM To evaluate the diagnostic accuracy of widely used parameters for bacterial infection in ACLF and to develop a simple scoring system to improve diagnostic efficiency.METHODS This was a retrospective study.Procalcitonin(PCT),white blood cells(WBC),proportion of neutrophils(N%),and C-reactive protein(CRP)were examined.Logistic regression was used to select variables for the scoring models and receiver operating characteristic curve(ROC)analysis was used to evaluate the diagnostic value of different indices.RESULTS This study included 386 patients with ACLF,169(43.78%)of whom had bacterial infection on admission.The area under the ROC(AUROC)of PCT,CRP,WBC and N%for the diagnosis of bacterial infection ranged from 0.637 to 0.692,with no significant difference between them.Logistic regression showed that only N%,PCT,and CRP could independently predict infection.A novel scoring system(infection score)comprised of N%,PCT and CRP was developed.The AUROC of the infection score was 0.740,which was significantly higher than that for the other four indices(infection score vs N%,PCT,CRP,and WBC,P=0.0056,0.0001,0.0483 and 0.0008,respectively).The best cutoff point for the infection score was 4 points,with a sensitivity of 78.05%,a specificity of 55.29%,a positive predictive value of 57.91%and a negative predictive value of 76.16%.CONCLUSION The infection score is a simple and useful tool for discriminating bacterial infection in ACLF.展开更多
乙型肝炎(乙肝)相关慢加急性肝衰竭(HBV related acute-on-chronic liver failure,HBV-ACLF)是肝病领域常见的急危重症,发病机制复杂,病情进展迅猛,治疗棘手,预后不佳,是目前研究的热点。人工肝及肝移植治疗存在诸多限制,目前仍以内科...乙型肝炎(乙肝)相关慢加急性肝衰竭(HBV related acute-on-chronic liver failure,HBV-ACLF)是肝病领域常见的急危重症,发病机制复杂,病情进展迅猛,治疗棘手,预后不佳,是目前研究的热点。人工肝及肝移植治疗存在诸多限制,目前仍以内科综合治疗为主,缺乏特效药物。由于免疫紊乱是其核心的发病机制,因此从免疫调节治疗角度出发,结合时相治疗理念,探索新的治疗策略,将有助于降低患者的病死率。本文将从ACLF的定义差异、发病机制及免疫调节治疗等方面进行综述。展开更多
基金Supported by the Chinese National Science and Technology Projects,No.2017ZX10202201.
文摘BACKGROUND The diagnosis of bacterial infection is difficult in patients with acute-on-chronic liver failure(ACLF).AIM To evaluate the diagnostic accuracy of widely used parameters for bacterial infection in ACLF and to develop a simple scoring system to improve diagnostic efficiency.METHODS This was a retrospective study.Procalcitonin(PCT),white blood cells(WBC),proportion of neutrophils(N%),and C-reactive protein(CRP)were examined.Logistic regression was used to select variables for the scoring models and receiver operating characteristic curve(ROC)analysis was used to evaluate the diagnostic value of different indices.RESULTS This study included 386 patients with ACLF,169(43.78%)of whom had bacterial infection on admission.The area under the ROC(AUROC)of PCT,CRP,WBC and N%for the diagnosis of bacterial infection ranged from 0.637 to 0.692,with no significant difference between them.Logistic regression showed that only N%,PCT,and CRP could independently predict infection.A novel scoring system(infection score)comprised of N%,PCT and CRP was developed.The AUROC of the infection score was 0.740,which was significantly higher than that for the other four indices(infection score vs N%,PCT,CRP,and WBC,P=0.0056,0.0001,0.0483 and 0.0008,respectively).The best cutoff point for the infection score was 4 points,with a sensitivity of 78.05%,a specificity of 55.29%,a positive predictive value of 57.91%and a negative predictive value of 76.16%.CONCLUSION The infection score is a simple and useful tool for discriminating bacterial infection in ACLF.
文摘乙型肝炎(乙肝)相关慢加急性肝衰竭(HBV related acute-on-chronic liver failure,HBV-ACLF)是肝病领域常见的急危重症,发病机制复杂,病情进展迅猛,治疗棘手,预后不佳,是目前研究的热点。人工肝及肝移植治疗存在诸多限制,目前仍以内科综合治疗为主,缺乏特效药物。由于免疫紊乱是其核心的发病机制,因此从免疫调节治疗角度出发,结合时相治疗理念,探索新的治疗策略,将有助于降低患者的病死率。本文将从ACLF的定义差异、发病机制及免疫调节治疗等方面进行综述。
