ALBI和EZ-ALBI评分对肝衰竭肝移植术后早期生存的预测价值

Predictive values of ALBI and EZ-ALBI scores for early survival of recipients with liver failure after liver transplantation

    摘要
  • 摘要:
      目的  探讨白蛋白-胆红素（ALBI）评分及简易白蛋白-胆红素（EZ-ALBI）评分对肝衰竭肝移植受者术后早期生存（术后3个月）的预测价值。
      方法  回顾性分析确诊为肝衰竭并接受肝移植治疗的137例受者的临床资料。通过受试者工作特征（ROC）曲线下面积确定术前ALBI、EZ-ALBI和终末期肝病模型（MELD）评分预测肝衰竭肝移植受者术后早期生存的最佳截取值，采用单因素及多因素Cox回归分析肝衰竭肝移植受者术后早期死亡的危险因素，分析不同ALBI和EZ-ALBI水平对肝衰竭肝移植受者术后早期预后的影响。
      结果  ALBI、EZ-ALBI和MELD评分的最佳截取值分别为0.21、-19.83和24.36，AUC分别为0.706、0.697和0.686。单因素Cox回归分析结果显示术前丙氨酸转氨酶（ALT）≥50 U/L、天冬氨酸转氨酶（AST）≥60 U/L、ALBI评分≥0.21和EZ-ALBI评分≥-19.83是肝衰竭肝移植受者术后早期死亡的危险因素（均为P < 0.05）；多因素Cox回归分析结果显示术前ALBI评分≥0.21是肝衰竭肝移植受者术后早期死亡的独立危险因素（P < 0.05）。根据ALBI评分的最佳截取值进行分组，ALBI < 0.21组（46例）和ALBI≥0.21组（91例）的早期生存率分别为93.5%和64.8%，差异有统计学意义（P < 0.05）；根据EZ-ALBI评分的最佳截取值进行分组，EZ-ALBI < -19.83组（60例）和EZ-ALBI≥-19.83组（77例）的早期生存率分别为88.3%和63.6%，差异有统计学意义（P < 0.05）。
      结论  术前ALBI评分对于肝衰竭肝移植受者术后早期生存情况有良好的预测价值，可以作为选择肝移植受者的参考指标。

     

    Abstract:
      Objective  To evaluate the predictive values of albumin-bilirubin (ALBI) and easy albumin-bilirubin (EZ-ALBI) scores for early survival (postoperative 3 months) of recipients with liver failure after liver transplantation.
      Methods  Clinical data of 137 recipients diagnosed with liver failure and underwent liver transplantation were retrospectively analyzed. The optimal cut-off values of preoperative ALBI, EZ-ALBI and MELD scores to predict early survival of recipients with liver failure after liver transplantation were determined by the area under the receiver operating characteristic (ROC) curve. The risk factors of early death of recipients with liver failure after liver transplantation were identified by univariate and multivariate Cox regression analyses. The effects of different ALBI and EZ-ALBI levels upon early prognosis of recipients with liver failure after liver transplantation were analyzed.
      Results  The optimal cut-off values of ALBI, EZ-ALBI and MELD scores were 0.21, -19.83 and 24.36, and the AUC was 0.706, 0.697 and 0.686, respectively. Univariate Cox regression analysis showed that preoperative alanine aminotransferase(ALT)≥50 U/L, aspartate aminotransferase(AST)≥60 U/L, ALBI score≥0.21 and EZ-ALBI score≥-19.83 were the risk factors for early postoperative death of recipients with liver failure after liver transplantation (all P < 0.05). Multivariate Cox regression analysis demonstrated that preoperative ALBI score≥0.21 was an independent risk factor for early postoperative death of recipients with liver failure after liver transplantation (P < 0.05). According to the optimal cut-off value of ALBI score, the early survival rates in the ALBI < 0.21 (n=46) and ALBI≥0.21(n=91) groups were 93.5% and 64.8%, and the difference was statistically significant (P < 0.05). According to the optimal cut-off value of EZ-ALBI score, the early survival rates in the EZ-ALBI < -19.83(n=60) and EZ-ALBI≥-19.83(n=77) groups were 88.3% and 63.6%, and the difference was statistically significant (P < 0.05).
      Conclusions  Preoperative ALBI score is of high predictive value for early survival of recipients with liver failure after liver transplantation, which could be utilized as a reference parameter for selecting liver transplant recipients.

     

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