Clinical Study Of Prognosis On Hepatitis B Virus Related Acute-on-Chronic Liver Failure

Objective: 1)To investigate the effects of plasma bilirubin adsorption(PBA)on survival and laboratory parameters in patients with hepatitis B virus related acute-on-chronic liver failure(HBV-ACLF);To discuss independent correlative factors of short term prognosis in patients with HBV-ACLF.2)To evaluate the predictive value of CTP,MELD,MELD–Na,LRM,CLIF-SOFA,CLIF-C OFs,CLIF-C ACLFs and NSS scoring systems.Methods: 1)The study was performed in patients who were hospitalized in our hospital from January 2010 to January 2016.All of the patients were followed for 90-day.Patients were divided into two groups: PBA group(plasma bilirubin adsorption plus standard medical therapy)and Control group(standard medical therapy alone).Cumulative survival rates were estimated by the Kaplan-Meier method and compared by log-rank test;COX regressions were performed to identify independent correlative factors in patients with HBV-ACLF.2)The area under the curve(AUC)were used to compare the predictive value of CTP,MELD,MELD-Na,LRM,CLIF-SOFA,CLIF-C OFs,CLIF-C ACLFs and NSS scoring systems in patients with HBV-ACLF.Result:1)A total of 221 patients with HBV-ACLF were included in this study.2)The90-day survival rates were 57.50% in the PBA group and 43.56% in the Control group(Log-rank test,P=0.011).The 90-day survival rates of the MELD<30 and MELD≥30 patients of PBA group were 67.71% and 16.67%,respectively,whereas the survival rates of the Control group were 50.63% and 18.18%,respectively.3)In patients who received PBA treatment a significant decreased in serum TBIL,ALP,GGT,TBA,ammonia,and interleukin-6 could be observed at day 7.At day 14,PBA group serum TBIL,ALP,GGT,TBA rebound,but still were better than that before treatment.4)TBil,white blood cells,cystatin,and hepatic encephalopathy are independent risk factors.5)At day 28,the AUC values of CTP,MELD,MELD-Na,LRM,CLIF-SOFA,CLIF-C OFs,CLIF-C ACLFs,NSS scoring systems were 0.758,0.721,0.708,0.770,0.865,0.850,0.810,0.697,respectively.The AUC value of CLIF-SOFA scoring system was higher than the AUC values of CTP,MELD,MELD-Na,LRM,CLIF-ACLFs and NSS scoring systems(P<0.05).At day 90,the AUC values of CTP,MELD,MELD-Na,LRM,CLIF-SOFA,CLIF-C OFs,CLIF-C ACLFs,NSS scoring systems were 0.739,0.728,0.737,0.701,0.788,0.795,0.752,0.710,respectively.The AUC value of CLIF-C OFs scoring system was higher than the AUC values of MELD,LRM and NSS scoring systems(P<0.05).Conclusion: 1)PBA therapy can reduce the mortality rate of the HBV-ACLF patients of MELD<30.2)The use of PBA as compared with the Control group was associated with a significant reduction in serum TBIL,ALP,GGT,TBA,ammonia,and interleukin-6.3)TBil,white blood cells,and hepatic encephalopathy were independent risk factors of patients with HBV-ACLF.4)CTP,MELD,MELD-Na,LRM,CLIF-SOFA,CLIF-C OFs,CLIF-C ACLFs and NSS scoring systems can predict short-term mortality of HBV-ACLF patients,CLIF-SOFA and CLIF-C OFs scoring systems were the better.