A Study Of The Relationship Between The Prognostic Nutritional Index Of Onodera And The Hepatic Failure

Abjective:The hepatic failure is one of the main types of hepatopathy.It has been caused by a number of factors and enormously damages the hepatocytes.They give rise to obstacles or decompensation to the hepatic synthetic functions,alexipharmic functions,biotransformational functions and other functions and a clinical syndrome major represented by the dysfunction of jaundice and coagulation,the hepatic encephalopathy,the hepatic ascites and so on.The hepatic failure is one of the common seen clinic sever liver diseases syndrome with extremely high fatality.The poor prognosis of patients with hepatic failure often depends on the cause of disease,the age of onset,the course of the disease and various other factors.At present,the MELD is the more frequently used method of judging the degree and the prognosis of the hepatic failure.The evaluation of the hepatic failure can not only guide the clinical treatment,predict the prognosis of patients with the hepatic failure,but can also optimize medical resources allocation and increase the liver transplantation resource utilization rate.Now the prognostic scoring systems of the hepatic failure at home and abroad are mainly MELD,CTP,the standards of the king's college hospital of University of Edinburgh,the sequential organ failure assessment,and the Lille model.Onodera's prognostic nutritional index is proposed by Japanese scholar Onodera and is a evaluation system for the nutritional status and the immune state of patients.Recent studies have found that the OPNI is related to the prognosis of various digestive system neoplasm.However,we need further researches to proof its value in clinical practice to decide whether it can be used as the evaluation index of the prognosis.This paper explores the OPNI's relations with the hepatic failure and its clinical application value.Methods:After analyzing the clinical data of 90 patients with liver failure in Hu Bei Provincial Hospital of TCM from January 2015 to November 2017 and collecting the gender,age,family history,past history,alcohol and tobacco history of patients in each case,blood,liver and kidney function,coagulation,hepatitis B three lines,AFP(AFP)and other related test results,we find that the patient's OPNI was calculated and divided into high OPNI group(OPNI?45)and low OPNI group(OPNI<45),in this paparwe compared the differences in clinical characteristics between the two groups and analyzed the relationship between OPNI and PTA ? neutrophil lymphocyte ratio(NLR),platelet lymphocyte ratio(PLR),Child-Pugh modified grading,and end-stage liver disease(MELD)Correlation.Results:The OPNI with patients averages 37.16�6.77.,The OPNI was higher in patients who have cirrhosis(P<0.05),hypertension(P<0.01),HBsAg positive(P<0.05),AFP negative(P <0.05),AST(P<0.01),ALT(P <0.01),(P<0.05)and of whom with higher albumin and lighter jaundice(P<0.05).There was a significant difference in NLR,PLR,CTPand MELD scores between the two groups(P<0.01).TCM syndromes are directly related to OPNI of liver failure,and the damp-heat resistance type is higher than that of cold,wet and spleen-type,heat-toxic flaming type.There was no significant difference in gender,age,alcohol and tobacco history,family history of liver disease,diabetes,cholelithiasis and blood ammonia between the two groups(P> 0.05).There was a positive correlation between OPNI and PTA(R=0.308,P<0.01).The OPNI was strongly negatively correlated with NLR(R=-0.527,P<0.001);OPNI was negatively correlated with PLR(R=-0.359,P<0.01).The OPNI and CTP method was strongly negatively correlated(R=-0.672,P<0.001);The OPNI and MELD score were negatively correlated with moderate intensity(R=-0.285,P<0.01).The three-month survival rates for the low OPNI and high OPNI groups were 64.2% and 100%,respectively.Conclusion: OPNI can be used as a simple and an effective indicator to help assess the severity and prognosis of patients with liver failure.The laboratory objective indexes of ALT,ALB,ALB,Jaundice,HBsAg and AFP in patients with liver failure are the direct risk factors of OPNI and the cirrhosis,history of hypertension and OPNI in patients with liver failure have a certain correlation.