A Retrospective Clinical Study Of Prognosis On Acute-on-chronic Liver Failure

Objective To discuss independent risk factors of short term prognosis in patients of acute on chronic liver failure (ACLF). To evaluate the diagnositic value of CTP scoring system, MELD scoring system, MELD-Na scoring system and SOFA scoring system for ACLF. To evaluate the effect of artificial liver treatment on the prognosis of various ACLF patients. To evaluate the effect of nucleoside analogues of antiviral therapy on the prognosis of various patients with HBV-related ACLF.Methods Retrospective analysis was applied in studying the medical aspects of362patients with acute on chronic liver failure patients between May2005to May2011in Tianjin third centure hospital, and the fatality rate in the three months. Data was analyzed with SPSS17.0software, t test was used on quantitative data, chi-square was used on qualitative data, then Logistic regression was used to screen independent risk factors affecting prognosis in patients with ACLF; Receiver operating characteristic curve (ROC) and the area under the curve (AUC) was used to compare the prognostic value of CTP, MELD, MELD-Na, SOFA scoring system in ACLF patients; Survival analysis was performed using the Kaplan-Meier method, Log-rank test was used to compare survival rate between the groups to evaluate the effect of artificial liver treatment and antiviral therapy on the prognosis of different period of ACLF patients.Result1.195patients died within three months of the362patients with ACLF, the mortality rate was53.8%.2. Logistic regression analysis showed that age>50years, TBil, PTA, WBC, serum sodium, SOFA scoring system, cirrhosis, upper gastrointestinal bleeding and hepatic encephalopathy are independent prognostic risk factors.3. The AUC of SOFA scoring system was0.818, which was higher than the AUC of CTP, MELD and MELD-Na, the difference was statistically significant (P<0.05); but between each two of the CTP, MELD, MELD-Na, there was no significant difference (P>0.05).4. The mortality of artificial liver treatment group in ACLF early,.mid period was27.1%and35.4%, respectively, compared to the control group (46.6%and55.3%) there were significant difference (P<0.05). while in advanced period (65.1%vs70.2%) there was no significant difference (P>0.05).5. The mortality of nucleoside analogue antiviral treatment group in HBV-related ACLF mid period patients was31.0%, compared to the control group (62.5%) there was a significant difference (P<0.05), while in early and advanced period (21.0%vs29.1%,68.8%vs68.4%) there were no significant difference (P>0.05).Conclusion1. age>50years, TBil, PTA, WBC, serum sodium, SOFA scoring system, cirrhosis, upper gastrointestinal bleeding and hepatic encephalopathy were independent risk factors affectting the short-term prognosis of patients with ACLF.2. CTP, MELD, MELD-Na and SOFA scoring system can predict short-term prognosis of ACLF patients, SOFA scoring system was the best.3. Artificial liver treatment therapy can reduce the mortality rate of the early and mid-term ACLF patients.4. Nucleoside analogue antiviral treatment can reduce mortality of the mid-term HBV-related ACLF patients.