ABSTRACT
Objective To investigate clinical characteristics of patients with liver failure accompanied with non-thyroid sick syndrome (NTIS) and the predictive value for short-term prognosis.Methods Ninety patients with liver failure hospitalized in Tianjin Second People's Hospital from January 2013 to December 2017 were retrospectively enrolled.Among them,75 patients (liver failure group) were randomly selected to establish prognostic models and the other 15 were selected for model validation.Another 75 patients at the same time of hospitalization with chronic hepatitis were randomly selected as the control group.The serum free triiodothyronine (FT3),free thyroxine (FT4) and thyroid-stimulating hormone (TSH) were measured by chemiluminescence.The clinical characteristics and survival rates 3 months after admission of patients with liver failure accompanied with NTIS were analyzed.The predictive value of the model for end-stage liver disease (MELD) score,Child-Turcotte-Pugh (CTP) score,chronic liver failure-sequential organ failure assessment (CLIF-SOFA) score,FT3-MELD model and FT3 for prognosis of liver failure were evaluated.Quantitative data were analyzed with Student's t-test and Mann-Whitney U test.Count data were analyzed with chi-square test.Results The liver failure group had significantly lower levels of FT3,TSH and albumin (Alb),but higher levels of total bilirubin (TBil),international normalized ration (INR),serum creatinine (Cr) and FT4 than the control group.NTIS was diagnosed in 50 patients with liver failure (50/75,66.67％).There were 32 deaths in patients with NTIS and 7 in patients with non-NTIS.The difference was statistically significant (x2 =8.654,P =0.003).INR,Cr,FT3,MELD score,CTP score and CLIF-SOFA score were significantly different between the survival and death groups (t =-3.037,t =-2,720,t =4.100,t =-4.221,t =-3.471,and t =-3.901,respectively;all P ＜ 0.01).A negative correlation was observed between FT3 and MELD score (r =-0.439,P ＜ 0.01).The area under the receiver's operating characteristic (ROC) curve of the FT3-MELD model was 0.816,with the optimal cut-off-point of 0.121 7,sensitivity of 0.769 and specificity of 0.833.The areas under the curve of the FT3,MELD score,CTP score and CLIF-SOFA score were 0.794,0.775,0.699,and 0.739,respectively.Conclusions Liver function and thyroid function are poor in patients with liver failure accompanied with NTIS.The FT3-MELD model is superior to CTP score and CLIF-SOFA score in predicting the short-term prognosis in patients with liver failure.
ABSTRACT
Objective To investigate the efficacy of the indocyanine green (ICG) clearance test (ICGR15) combined with the model for end-stage liver disease (MELD) for assessing the short-term prognosis of patients with liver failure.Methods Eighty patients with liver failure were analyzed retrospectively.ICGR15 and relevant clinical data within 24 hours of diagnosis were analyzed.Meanwhile,the MELD score and King's College Hospital (KCH) were evaluated.All findings were tested for correlation with 3-month mortality.Quantitative data were analyzed with analysis of variance and Student's t-test.Count data were analyzed with chi-square test.Correlation analysis was performed with Pearson's coefficient test.Results Among 80 patients with liver failure,39 patients survived and 41 died.The mortality rate of all patients was 51.2％.The serum total bilirubin,creainine concentrations,ICGR15,MELD scores and patient number in accordance with KCH criteria of surviving patients were (288.0±109.1) μmol/L,(63.3±24.4) μmol/L,(48.1±10.2)％,20.6±4.4,and 6 cases,respectively,which were lower than those in dead patients [(340.7 ± 108.2) μmol/L,(98.8 ± 59.1) μmol/L,(60.2 ± 10.6) ％,26.9 ± 7.1 and 19 cases,respectively] (P =0.033,P＝ 0.001,P＝ 0.000,P＝ 0.000 and P =0.003,respectively).There was no significant difference of ICGR15 among four types of liver failure.A positive correlation was observed between ICGR15 and MELD score (r=0.289,P=0.009).The ICGR15-MELD model was created by subjecting ICGR15 and MELD scores to Logistic regression analysis.The following ICGR15-MELD model,Logit (P) =0.105 × ICGR15 + 0.178 × MELD score-9.734,was constructed by Logistic regression analysis.The area under the receiver operating characteristic (ROC) curve was 0.860 and the cut offpoint of 0.3 had sensitivity of 85.40％ and specificity of 74.40％.The area under the curve of the ICGR15-MELD model was significantly higher than those of ICGR15 (0.791),MELD score (0.770) and KCH criteria (0.655).Conclusions ICGR15 and MELD scores perform better than the KCH criteria in predicting the prognosis of liver failure.The ICGR15-MELD model is superior to ICGR15,MELD score,and KCH in predicting the short term prognosis of patients with liver failure.