Different Models In Prediction Of Short-term Prognosis Of Hepatitis B Virus Related Acute-on-chronic Liver Failure

Objective:Acute-on-chronic liver failure(ACLF)is a clinical syndrome characterized by an acute deterioration of liver function associated with one or more organs failure and high short-term mortality and poor prognosis,which arouse a concern widely.Therefore,early diagnosis,evaluation of prognosis and timely intervention can improve the survival rate and the timing of liver transplantation in patients with ACLF.This study analyzes the clinical characteristics and prognosis of 192 patients with hepatitis B related ACLF(HBV-ACLF).By evaluating and comparing the predictive efficacy of the six scoring models individually or in combination,a more sensitive prognostic scoring model was proposed to guide the selection of the optimal treatments.Methods:A total of 192 cirrhosis patients with HBV-ACLF diagnosed in the First Hospital of Jilin University from January 2015 to July 2020 were included.The general characteristics,laboratory tests,prognosis of 28-day and 90-day were recorded,and the prognosis scores of each patient were calculated respectively.The SPSS software version 22 was used to compare the clinical data between survival group and death group.Area under the receiver operating curve(AUC)was calculated to evaluate the prognostic value of the scoring models in predicting short-term prognosis of HBVACLF patients,and the scoring systems were combined and compared again.Results:1.Of the 192 patients with HBV-ACLF,155(80.7%)were male and 37(19.3%)were female.45 patients died in 28 days and the mortality was 23.4%,64 patients died in 90 days and the mortality was 33.3%.2.The predisposing factors of all patients with HBV-ACLF: 73(46.9%)had infection;52(18.2%)had undefined;21(11.5%)had stop using antivirals;20(10.4%)had hepatotoxic drugs;10(5.2%)cases with physiological exhaustion;9(4.7%)had gastrointestinal bleeding;3(1.6%)cases with other hepadnavirus infections;2(1.0%)had surgery in past 3 months;2(1.0%)had virus mutation;1(0.5%)had used immunosuppressive agents.3.Liver failure(79.2%)and coagulation failure(35.4%)were much more frequently observed in this study.The incidence of liver failure,coagulation failure,renal failure,cerebral failure,circulatory failure and respiratory failure in the 28-day death group were higher than that in the survival group(liver failure P=0.066,the other P < 0.05).The incidence of liver failure,coagulation failure,renal failure,cerebral failure,circulatory failure and respiratory failure in 90-day death group were higher than that in the survival group(P < 0.05).4.HBV-ACLF staging and mortality: The 28-day mortality of HBV-ACLF patients at early,middle and late stage were 6.1%,16.3%,and 52.9%,respectively and the 90-day mortality at early,middle and late stage were 8.2%,30.4%,and 62.7%,respectively and the difference was statistically significant(P<0.05).5.The scores of the six prognostic scoring models in the death group were significantly higher than those in the survival group.When the six models were used alone,the AUC of COSSH-ACLF score in predicting the 28-day and 90-day mortality of HBV-ACLF patients was the largest,which were 0.958 and 0.930,respectively.Compared with the AUC of the optimal prognosis models of the three methods(separate,series and parallel),we could know that COSSH-ACLF>CTP-ABIC parallel COSSHACLF>MELD-Na cascade COSSH-ACLF,and the difference was statistically significant(P<0.05).6.In the prediction of 28-day mortality,the CLIF-C ACLF parallel COSSH-ACLF had the highest sensitivity,up to 100%,which was higher than that of the single model.MELD in series with COSSH-ACLF,CLIF-C ACLF in series with COSSH-ACLF,CTP-ABIC in series with COSSH-ACLF had the highest specificity,up to 93.2%,which was higher than that of the single model.7.In the prediction of 90-day mortality,the MELD-Na parallel COSSH-ACLF had the highest sensitivity,up to 98.4%,which was higher than that of the single model.The iMELD in series with COSSH-ACLF had the highest specificity,up to 89.8%,which was higher than that of the single model.Conclusions:1.The 28-day transplant-free mortality of HBV-ACLF patients was 23.4%,and the 90-day transplant-free mortality was 33.3%.2.The organ failure of HBV-ACLF patients is mainly liver failure and coagulation failure.3.The predictive value of COSSH-ACLF score model for short-term prognosis of HBV-ACLF patients was better than MELD,MELD-Na,iMELD,CTP-ABIC and CLIF-C ACLF.4.The CLIF-C ACLF parallel COSSH-ACLF score had the highest sensitivity of100% for predicting 28-day mortality,suggesting that this model could be used to 100%identify patients who died at 28 days.The MELD-Na parallel COSSH-ACLF score had the highest sensitivity of 98.4% for predicting 90-day mortality.