Clinical Value Of CysC In Predicting AKI And Short-term Prognosis In Patients With ACLF

Objective:The purpose is to analyze various common laboratory data of patients with acute on chronic liver failure（ACLF）,analyze and find out important indicators that can effectively predict acute kidney injury（AKI）and short-term prognosis of patients with ACLF through different grouping comparison,and evaluate them,hoping to provide some help for clinicians to evaluate patients’ condition and improve patients’ prognosis in the future.Methods:95 patients with ACLF who were admitted to the infectious diseases department of the First Affiliated Hospital of Bengbu Medical College were collected among July2018 to December 2020.The clinical data,such as gender,age,etiology and so on were collected,and collect the important peripheral blood test results of patients within 24 hours after admission.The Child-Turcotte-Pugh（CTP）score and Model for End-stage Liver Disease（MELD）score of each patient were calculated.According to the 30 day survival prognosis,the patients with ACLF were divided into death group and survival group.Then,according to whether the patients were complicated with AKI,they were divided into AKI group and non AKI group.The above data were analyzed retrospectively,and the risk factors affecting the prognosis of patients with ACLF were analyzed by logistic regression,receiver operating characteristic curve（ROC curve）was used to evaluate the efficacy of relevant indicators and models in the occurrence of AKI and adverse prognosis.Results:1.The causes of ACLF patients were distributed as follows: hepatitis B related62 cases（66%）,alcohol related 17 cases（18%）,hepatitis B and alcohol related 4cases（4%）,drug related 4 cases（4%）,autoimmune related 3 cases（3%）,hepatitis C related 2 cases（2%）,unexplained 2 cases（2%）and hepatolenticular degeneration 1case（1%）.2.There was no significant difference in age and sex between the death group and the survival group,AKI was different between the two groups,but there was no significant difference in ascites,upper gastrointestinal bleeding,Hyponatremia,infection and hepatic encephalopathy between the two groups.3.The Cr was in the normal range between the two groups with AKI or not and between the two groups with different prognosis,and there was no difference（P >0.05）,while the CysC was higher than the normal among the above groups,and the difference was significant（P < 0.05）.The ROC curve suggested that CysC had a strong prediction efficiency of AKI,which was better than Cr.4.Univariate and multivariate regression analysis showed that CysC was an independent risk factor affecting the short-term（30d）prognosis of patients with ACLF.5.CysC was positively correlated with MELD score（r = 0.611,P < 0.01）,but weakly correlated with CTP score.6.ROC curve suggests that CysC has a better predictive value for the short-term prognosis of patients with ACLF,which is better than CTP score,but worse than MELD score.Conclusion:1.The causes of ACLF in our hospital are mainly related to hepatitis B and alcohol.2.The occurrence of AKI is related to the poor prognosis of patients with ACLF.3.CysC can predict AKI in patients with ACLF earlier and more accurately than Cr.4.CysC is an independent risk factor affecting the short-term prognosis of patients with ACLF,and has a certain value in predicting the short-term prognosis.