Retrospective Analysis Of Short-term Prognosis In 81 Cases With Acute-on-chronic Liver Failure

Objective:1.Based on a retrospective analysis of 81 patients with chronic acute liver failure,the etiology of patients with acute-on-chronic liver failure(ACLF)was summarized.2.To explore the independent risk factors of short-term prognosis(90 days)in patients with chronic acute liver failure(ACLF).3.To explore the predictive value of end-stage liver disease model(MELD score),neutrophil-lymphocyte ratio(NLR)and MELD combined with NLR on the 90-day prognosis of patients with acute-on-chronic liver failure.Methods:Retrospectively collected clinical data of 81 patients with ACLF who met the criteria from 2016 to 2019 in our Department of Infectious Diseases,including basic data,laboratory indicators,complications,MELD scores,and NLR.Survival group and death group.An independent sample t test was used for comparison between the two groups.Logistic regression analysis was introduced for variables that were significant in univariate analysis to determine independent risk factors for the short-term prognosis of chronic and acute liver failure.Using MedCalc 15.8 software to analyze and compare the receiver operating characteristic curve(ROC)and the area under the curve(AUC)to evaluate the MELD score,NLR,MELD + NLR for predicting the short-term prognosis of patients with chronic acute liver failure.Results:1.Analysis of the etiology of ACLF: 42 cases of hepatitis B(51.85%),16 cases of alcoholic cirrhosis(19.75%),9 cases of autoimmune liver disease(11.11%),6 cases of unexplained cirrhosis(7.41%),3 cases of cirrhosis of liver Cases(3.70%),2 patients with alcoholic liver combined with hepatitis B(2.47%),3 patients with chronic hepatitis B combined with drug-induced liver injury(3.70%),short-term(90d)mortality of ACLF patients was 43.21%,survival group and death among different etiology There was no statistical difference in the group(P>0.05).2.Complications and prognosis: Hepatic encephalopathy,hepatorenal syndrome,and upper gastrointestinal bleeding in the death group of ACLF patients were significantly higher than those in the survival group(P <0.05),but there was no significant peritoneal effusion,abdominal infection,or pulmonary infection between the two groups.Difference(P>0.05).3.Laboratory indicators and prognosis: Age,TBIL,ALB,ALP,NLR,PTA,INR,FT3,TSH,Lac,and MELD scores have an impact on the short-term prognosis of patients with ACLF(P <0.05),while ALT,AST,PA,CHE,GGT,TBA,WBC,Cr and FT4 are not significant for short-term prognosis(P>0.05).4.Take statistically significant indicators: age,TBIL,ALB,ALP,NLR,PTA,INR,FT3,TSH,Lac,and MELD scores,hepatic encephalopathy,hepatorenal syndrome,upper gastrointestinal bleeding as Logistic Regression analysis revealed that INR,NLR,MELD score,hepatic encephalopathy,and upper gastrointestinal bleeding were independent risk factors for patients with chronic and acute liver failure(P <0.05).5.The AUC of MELD score is 0.869,and the AUC of NLR is 0.771.Both scoring systems have a better diagnostic value for the prognosis of chronic acute liver failure(AUC> 0.70).The NLR score is better than the MELD score for patients with chronic acute liver failure.The predictive value is good(AUC 0.869> 0.771).MELD score combined with NLR score can further increase the sensitivity and specificity of the prognosis.Conclusion:1.Hepatitis B-related chronic and acute liver failure is still the main cause of ACLF,followed by alcoholic liver disease.2.INR,NLR,MELD score,hepatic encephalopathy,upper gastrointestinal bleeding are independent risk factors for patients with chronic and acute liver failure.3.Both NLR and MELD scores can predict the prognosis of patients,but NLR is better than MELD.The combination of the two can further improve the sensitivity and specificity of prediction.