血清LCN-2、sTREM-1、S100A8/A9水平与老年急性肝衰竭并发肝性脑病患者临床结局的相关性分析OA

Objective To investigate the relationship between serum Lipocalin-2(LCN-2),soluble triggering receptor expressed on myeloid cells-1(sTREM-1),calprotectin(S100A8/A9)and clinical outcomes in elderly patients with acute liver failure(ALF)complicated by hepatic encephalopathy(HE).Methods Clinical data of 242 ALF patients admitted to the Department of Infectious Diseases,Xinyu City People's Hospital from May 2018 to May 2024 were collected for retrospective analysis.After excluding cases with missing key variables exceeding 20%,the propensity score matching method was used to assign patients to HE group(n=100)and non-HE group(n=100)at a 1:1 ratio.Serum levels of LCN-2,sTREM-1,and S100A8/A9 were measured.The clinical outcomes of ALF patients complicated by HE were analyzed,and based on these outcomes,the patients were categorized into poor outcome group(n=55)and good outcome group(n=45).Multivariate logistic regression was used to analyze factors influencing clinical outcomes in ALF patients complicated by HE.The value of LCN-2,sTREM-1,and S100A8/A9 in predicting clinical outcomes was assessed using receiver operating characteristic(ROC)curve analysis.Hosmer-Lemeshow test was employed to evaluate the goodness-of-fit of the model.Results Serum levels of LCN-2,sTREM-1 and S100A8/A9 in HE group were higher than those in non-HE group(P<0.05).Among the 100 ALF patients with HE,45 cases had good outcomes(all showed improvement),while 55 had poor outcomes(36 deteriorated and 19 died).Serum levels of LCN-2,sTREM-1,and S100A8/A9 in poor outcome group were significantly higher than those in good outcome group(P<0.05).West-Haven grade,international standardized ratio(INR),LCN-2,sTREM-1,and S100A8/A9 were identified as risk factors for poor clinical outcomes in ALF patients with HE(P<0.05).The areas under the ROC curve(AUC)for LCN-2,sTREM-1,and S100A8/A9 in predicting clinical outcome were 0.763,0.784,and 0.757,respectively.The combined prediction model yielded an AUC of 0.937,which was significantly higher than that of any single indicator(P<0.05).Hosmer-Lemeshow test results showed a good model fit(χ²=5.326,P=0.326).Conclusion Elevated serum levels of LCN-2,sTREM-1,and S100A8/A9 in elderly ALF patients with HE are associated with adverse clinical outcomes,and the combination of these three biomarkers demonstrates high predictive value for poor outcomes.