Comparing Different Scoring Models Of Predicting The Short-term Mortality For End-stage Alcoholic Liver Disease

AimPatients with end-stage liver disease progress rapidly and have a high mortality rate.In this study,we retrospective analysis the patients of alcohol-related acute-on-chronic liver failure(ACLF)and severe alcoholic hepatitis(SAH).1.By comparing Age,Bilirubin,INR,Creatinine(ABIC),Maddrey's discriminant function(MDF),model for end-stage liver disease(MELD),chronic liver failure-sequential organ failure assessment(CLIF-SOFA)and Child-Turcotte-Pugh(CTP)scoring systems that predict the short-term prognosis of patients,to help physicians achieve accurate progression of alcohol-related ACLF patients and eventually improved outcomes of alcohol-related ACLF patients.2.To analyze the clinical features of SAH and compare the predictive value of five scoring systems,thereby assist physicians deepen their understanding of SAH.MethodConsecutive 546 patients with live failure were retrospectively collected from August 2005 to November 2017 from Tianjin third central hospital and 154 patients with alcohol-related ACLF were enrolled ultimately according to inclusion criteria and exclusion criteria.We divided patients into group A that accorded with criteria of Asian Pacific Association for the Study of the Liver(APASL)but not accorded with criteria of European Association for the Study of the Liver-Chronic Liver Failure(EASL-CLIF)and group B that conformed to criteria of EASL-CLIF on admission.The performance of scoring models for predicting short-term mortality was assessed using the areas under the receiver operating characteristic curve(AUC-ROC).In addition,Consecutive 168 patients with SAH were retrospectively collected from August 2005 to November 2017 from Tianjin third central hospital.According to the 28 d survival situation,patients were divided into survival group(group?)and death group(group?),the baselines of two groups were compared.Multivariate Logistic regression analysis was applied for selecting the risk factors of short-term prognosis and using AUROC to assess the predictive value of the five scoring models for the short-term prognosis of patients with SAH.Result1.The 28-day mortality of group A and group B was 19% and 50% respectively(P=0.002).In group A,the AUC of CLIF-SOFA that predicted the 28-day mortality was 0.889,followed by MELD(0.761),MDF(0.738),ABIC(0.718)and CTP(0.671)and there was a significant difference between CTP and the others.In group B,the AUC of CLIF-SOFA was 0.916,followed by MELD(0.804),MDF(0.770),ABIC(0.729)and CTP(0.647)and there was a significant difference between CLIF-SOFA and the others and between CTP and the others.2.The mortality rate of patients with SAH in 28 days was 46.0%,Age?bacterial infections?ALB?ALT?GGT?TBil?PT?INR? WBC? HGB?PLT?MELD?MDF?ABIC?and CLIF-SOFA scores had significant difference between group I and group II(P<0.05).Multivariate Logistic regression analysis showed that age,bacterial infection?INR?HGB?MELDand CLIF-SOFA were independent risk factors for prognosis.The AUC for the MDF?MELD?ABIC?CTPand CLIF-SOFA scoring models were 0.744?0.859?0.738?0.716 and 0.906,respectively.ConclusionThe five scoring systems could all predict the short-term prognosis of two groups.However,CLIF-SOFA performed well compare to the others whether in group A or in group B.Patients with SAH had high 28-day mortality.Age?bacterial infection?INR?HGB?MELD and CLIF-SOFA were independent risk factors affecting their prognosis.CLIF-SOFA could better evaluate the short-term prognosis of SAH patients.