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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.
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Objective To investigate the prognostic factors for clinical relapse in chronic hepatitis B (CHB) patients with hepatitis B e antigen (HBeAg) seroconversion after drug withdrawal and to establish a prognostic model.Methods Totally 201 CHB patients with HBeAg seroconversion after the antiviral therapy were enrolled.The epidemiological variables including age, gender and family history of hepatitis B were collected.Liver function and hepatitis B virus (HBV) DNA level one week before initiation of antiviral therapy, hepatitis B surface antigen (HBsAg) level at the time of drug withdrawal and the duration of antiviral therapy after HBeAg seroconversion were analyzed.The clinical relapse after 48 weeks of drug withdrawal was followed up.The patients were divided into relapse group and non-relapse group according to clinical variables at 48 weeks after drug withdrawal.The counting data were analyzed by chi-square test and the measurement data were analyzed by t test.The Logistic regression model was used to determine the prognostic factors for clinical relapse.The receiver operating charactenstic (ROC) curve was constructed to assess the performance of the prediction model.Results The clinical relapse rate was 16.42% (33/201) after 48 weeks of drug withdrawal.By multivariate analysis, age, the duration of antiviral therapy after HBeAg seroconversion and HBsAg level at the time of drug withdrawal were independent predictors (χ2=14.546, t=3.202, t=3.286, respectively;all P<0.05).The regression model Logit (P)=1.220×age-0.040×the duration of antiviral therapy after HBeAg seroconversion +0.004×HBsAg level at the time of drug withdrawal-5.426.The sensitivity and specificity with the cut-off value of-0.860 were 73.10% and 90.40%, respectively.Conclusions Age, the duration of antiviral therapy after HBeAg seroconversion and HBsAg level at the time of drug withdrawal are independent predictors for clinical relapse 48 weeks after drug withdrawal in CHB patients with HBeAg seroconversion after antiviral therapy.
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Hepatic fibrosis is the common pathological basis of various chronic liver diseases.Liver biopsy remains the gold standard for the assessment and diagnosis of liver fibrosis,but its invasiveness and high requirements for operation limit its clinical application.This article introduces the development of noninvasive diagnosis of hepatic fibrosis,such as serological and imaging techniques.However,these methods cannot completely replace liver biopsy.Therefore,a comprehensive noninvasive diagnosis model for hepatic fibrosis has become a research hotspot.
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Objective To explore the nutritional risk factors in patients with chronic hepatitis C (CHC), who have been accepted pegylated interferon (IFN) and ribavirin (RVB) therapy (PR). Methods A total of 175 CHC patients treated with PR were included in this study. Data of heights, body weights, and calculated body mass index (BMI) were recorded in patients. At the same time, patients were evaluated nutritional risk with Nutritional Risk Screen 2002 (NRS 2002), and divided into risk group (n=35) and non-risk group (n=140). Results There were significant differences in age, HCV genotype (1b type and not 1b), clinical type (CHC/cirrhosis), the length of treatment time and the tolerance degree for PR therapy between two groups (P<0.05). Logistic regression analysis showed that age (OR=16.068,β=2.777), IFN dosage (OR=3.096, β=1.130), RVB dosage (OR=3.382, β=1.219) and clinical type (OR=5.092, β=1.628) were nutritional risk factors. The HCV genotype (OR=0.384; β=-0.957) was protective factors for nutritional risk. Conclusion There is higher occurrence rate of nutritional risk for CHC patients accepted PR therapy. The dependant nutritional risk factors are advanced age, intolerance for PR therapy and cirrhosis associated CHC. HCV without genotypes 1b is not a nutritional risk factor.
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Objective To investigate the value of model for end-stage liver disease (MELD) score, MELD with in-corporation of serum sodium (MELD-Na) score and integrated MELD (iMELD) score for evaluation of prognosis of chronic liver failure. Methods A total of 159 consecutive patients with chronic liver failure were included in the study and divided into two groups (death group and survival group) according to the prognosis. The levels of total bilirubin (TBIL), serum creati-nine (Cr), prothrombin time (PT), PT international normalized ratio (INR), serum sodium (Na+), age, MELD, MELD-Na and iMELD were calculated respectively and the comparative analysis was performed. Areas under the receiver operating charac-teristic curve (AUC-ROC) of MELD, MELD-Na and iMELD were used to assess the prognosis in patients with chronic liver failure. Results The values of TBIL (μmol/L:330.9±181.9 vs 245.5±127.7),Cr (μmol/L:84.9±63.8 vs 81.2±49.3),INR (2.50±1.01 vs 2.09±0.57),MELD (26.2±6.5 vs 22.0±5.8),MELD-Na (35.9±31.5 vs 25.3±8.7) and iMELD (49.5±17.4 vs 42.4±10.9) were significantly higher in death group than those in survival group (P 0.05) for MELD score (AUC=0.691), MELD-Na score (AUC=0.690) and iMELD score (AUC= 0.674) . The cut-off scores of three systems were 25.8 (MELD), 31.0 (MELD-Na) and 53.5 (iMELD) respectively, which could discriminate higher and lower mortality accurately. Conclusion MELD, MELD-Na and iMELD scores can predict short-term clinical outcomes of liver failure patients undergoing artificial liver comprehensive medical treatment.
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<p><b>OBJECTIVE</b>To investigate the short-term prognostic value of the indocyanine green clearance test when used in combination with the model for end-stage liver disease (MELD) scoring system to assess patients with hepatitis B virus acute-on-chronic liver failure (HBV-ACLF).</p><p><b>METHODS</b>Clinical data of 105 patients diagnosed with HBV-ACLF were retrospectively analyzed. The indocyanine green retention rate at 15 minutes (ICGR15), clinical data within 24 h after diagnosis, Child-Turcotte-Pugh (CTP) classification, MELD score, MELD combined with sodium concentration (MELD-Na) score, and King's Hospital (KCH) criteria data were collected for analysis. Measurement data were assessed by t-test and count data by the chi-square test. Short-term predictive accuracy for patients with HBV-ACLF was compared between different models using the area under the receiver operating characteristic (ROC) curve (AUC).</p><p><b>RESULTS</b>The mortality rate for all patients was 45.71%. Comparison of the survivors versus the non-survivors showed that age, total bilirubin, albumin, cholinesterase, creatinine, international normalized ratio, and incidence positive rate of relative complications (hepatorenal syndrome, hepatic encephalopathy) were significantly different between the two groups (all, P less than 0.05). The ICGR15 was found to be positively correlated with MELD score (r = 0.205, P less than 0.05). The MELD-ICGR15 model constructed by logistic regression analysis was: Logit(P) = 0.193 * MELD + 0.130 * ICGR15 - 11.256. The AUC was 0.880 and the cut-off was -0.706, with 89.6% sensitivity and 75.4% specificity. The AUC of the MELD-ICGR15 model was significantly higher than that of the ICGR15 (0.820), MELD score (0.779), MELD-Na score (0.761), KCH criteria (0.680), and CTP classification (0.631) (all, P less than 0.05).</p><p><b>CONCLUSION</b>ICGR15, MELD score, and MELD-Na score had higher predictive values for HBV-ACLF than did CTP classification or KCH criteria. Furthermore, the MELD-ICGR15 model was better than any single parameter model for predicting the short-term prognosis of patients with HBV-ACLF.</p>
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Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Acute-On-Chronic Liver Failure , Diagnosis , Virology , End Stage Liver Disease , Hepatitis B , Indocyanine Green , Predictive Value of Tests , Prognosis , Retrospective Studies , Severity of Illness IndexABSTRACT
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.
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Objective To investigate the mechanism of nuclear factor-kappa B(NF-κB)in thioactamide(TAA)induced acute hepatic injury.Methods Seventy-eight Wistar rats were randomly divided into normal group(n=18),TAA model group(n=30)and pyrrolidine dithiocarbamate (PDTC)pretreated group(n=30).The rats in PDTC group were received 100 rag/kg of PDTC 1 h before induction of the model.Every 10 rats in TAA group and PDTC pretreated group and 6 rats in normal group were sacrificed at 6,24,48 hour after induction of the model tO mesure levels of endotoxin,tumor necrosis factor(TNF)-α and interleukin(IL)-6.The expression of the intercellular adhesion molecular(ICAM)-1 in hepatic tissue was tested using RT-PCR and the NF-κB activity was 48 hour were higher in TAA group[(87.11±8.23)%.(78.55±6.82)%and(74.27±6.26)%,respectively]than those in normal group[(4.64±1.82)%,(4.55±1.67)%and(4.91±2.12)%,all comparison with normal group(P＜0.01).The serum concentration of endotoxin and TNF-α in PDTC pretreated group were higher than those in normal group(P＜0.0 1).but lower than those in TAA with ticrmal group(P＜0.01).The serum concentration of IL-6 in PDTC pretreated group was higher at 24 and 48 hour than those in normal group(P＜0.01),but lower than thoes in TAA group(P＜group(P＜0.01).The expression of ICAM-1 in PDTC pretreated group was higher than that in immunohistochemical examination showed that liver necrosis was folund in TAA group and PDTC pretreated group.Conclusion The Nuclear factor-κB may aggravate the injury of liver by promoting expressions of TNF-α,IL-6 and ICAM-1.
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OBJECTIVE To improve capability of nosocomial infection(NI) prevention and control in reusable textiles management.METHODS In an investigation to previous reused textiles handled procedure,care to keep from creation of potential infectious aerosols should not be taken in contaminated textiles collection,transportation of clean and soiled textile was done in undistinguished uncovered vehicles,sorting room shared a common space with dressing room and washing room,and personal protection was not performed in handling contaminated textiles.RESULTS A series of NI management as follows effectively were adopted in hospital laundry.Appropriate bags were adopted for collecting used textiles or fabrics at the point of generation and subsequently closed securely for transportation of them to the laundry.An independent sorting area with exclusive ventilation system was separated from other parts of the laundry.Hand hygiene facilities and products and appropriate personal protective equipments were available.Transportation and storage of clean from soiled textiles were separated.CONCLUSIONS Appropriate handling and processing textiles in infectious disease hospital plays key role in NI management.