| Hepatic encephalopathy(HE)is a neuropsychiatric syndrome based on metabolic disorders caused by acute and chronic severe liver dysfunction or various portal vein-systemic circulation shunt abnormalities.Recently,the classification standard made by the International HE and Nitrogen Metabolism Society has been widely used.This standard divides HE into cover HE and overt hepatic encephalopathy.HE not only increased the mortality,the incidence of falls and traffic accidents in patients with cirrhosis,but also was an independent risk factor that increased the risk of hospitalization and readmission for patients with cirrhosis.On the one hand,patients with hepatic encephalopathy bring heavy mental and economic burdens to their families and caregivers,on the other hand,they also occupy a large amount of medical resources.Studies have shown that mental damage persists after improvement of symptoms of HE,and the risk of recurrence would increase.Because of its high morbidity,high recurrence rate,and high mortality,HE has attracted more and more attention from clinicians.How to assess the prognosis of HE patients accurately,and allocate relatively limited medical resources reasonably are the problems that clinicians need to solve.OBJECTIVES1.To explore the influence factors of mortality within 30 days of patients with HBV cirrhosis complicated with OHE,and to establish a non-invasive scoring model to predict their mortality within 30 days.2.To explore the therapeutic effect of anti-liver fibrosis traditional Chinese medicine on patients with HBV cirrhosis complicated with OHE.METHODS1.We collected 935 patients with HBV cirrhosis complicated with OHE from January 2008 to April 2018 in Beijing Ditan Hospital affiliated to Capital Medical University retrospectively.According to the inclusion and exclusion criteria,616 patients were finally enrolled in this study.All patients were followed up for 30 days to record their prognosis(survival/death).The COX regression analysis was used to determine the factors of the prognosis within 30 days,and a non-invasive scoring model was established based on the influence factors.The external validation cohort consists of 107 patients with HBV cirrhosis complicated with OHE from a multicenter prospective cohort study of chronic and acute liver failure participating of 15 centers nationwide.2.The above 616 patients were selected as the screening object,and 316 patients were included as the research object according to the inclusion and exclusion criteria to explore the influence of anti-liver fibrosis traditional Chinese medicine on the prognosis.The 316 patients were divided into two cohorts according to whether they took anti-liver fibrosis traditional Chinese medicine,namely the traditional Chinese medicine cohort(TCM cohort,107 cases)and the non-traditional Chinese medicine cohort(Non-TCM cohort,209 cases).Outcome within 6 months of the two groups were compared(survival/death).RESULTS1.A training cohort consisted of 616 patients with HBV cirrhosis complicated with OHE to predict the mortality within 30 days,128 patients of whom died within 30 days,a mortality of 20.8%.The results of COX regression analysis showed that age,MELD score,and neutrophil-to-lymphocyte count ratio(NLR)were independent influence factors for mortality within 30 days(P<0.05).A formula model was established based on the coefficients of the COX multivariate regression analysis:R1=MELD+0.4*NLR+0.3*Age.The area under the curve(AUC)of this model was 0.834(95%CI:0.719-0.876)and C-index was 0.804(95%CI:0.764-0.844).Simplify the model further:R=MELD+NLR.The AUC of simplified model was 0.831(95%CI:0.790-0.872)and the C-index was 0.803(95%CI:0.764-0.842).In view of R1 relatively complex model,and its AUC and C index are not significantly different from the R model.The R model is more convenient for clinical applications,and the study turned it into a visual nomogram.According to cut-off values,patients were divided into high-risk group(R≥39),intermediate-risk group(39>R>23),and low-risk group(R≤23).The mortality of the three groups of patients within 30 days were 63.2%(43/68),36.2%(67/185),5.0%(18/363),respectively.In the Kaplan-Meier analysis,regardless of training cohort or validation cohort,the three groups showed significant statistical differences in cumulative survival rates(P<0.0001).And the R model was validated in an external cohort of 107 patients with HBV cirrhosis complicated with OHE,the R model in the external cohort had an AUC of 0.763(95%CI:0.673-0.853)and a C-index of 0.747(95%CI:0.674-0.820).2.According to the exclusion and inclusion criteria,a total of 316 patients were enrolled to explore the effect of anti-liver fibrosis traditional Chinese medicine on the prognosis within 6 months of patients with HBV cirrhosis complicated with OHE in part two study.We finally determined 107 cases of TCM cohort and 209 cases of Non-TCM cohort based on whether they took anti-liver fibrosis traditional Chinese medicine.There was no statistical difference in age,gender,complications,blood routine,biochemical and other tests between the two groups(P>0.05).The mortality in the TCM cohort was 1.9%(2/107),and the median survival time was 113 days.In the non-TCM cohort,the mortality rate was 8.1%(17/209)and the median survival time was 70 days.The Kaplan-Meier analysis of the TCM cohort and Non-TCM cohort showed that the cumulative mortality rate of TCM cohort is lower than the Non-TCM cohort(P=0.026).CONCLUSIONS1.This study found that the age,MELD score and NLR were independent influential factors of short-term prognosis of patients with HBV cirrhosis complicated with OHE(30 days).The improved MELD scoring model can well identify the high-risk population who died within 30 days.2.The anti-hepatic fibrosis traditional Chinese medicine is associated with lower mortality within 6 months in patients with HBV cirrhosis complicated with OHE and extends survival. |
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