Analysis Of Risk Factors For Short-term Survival Rate Of Patients With Acute-on-chronic Liver Failure And Establishment And Evaluation Of Prognostic Models

Objective:Understand the etiology,laboratory indicators and complications of patients with chronic acute liver failure,and further explore independent factors affecting the short-term survival rate of patients with chronic acute liver failure,establish a prognostic model,and provide clinical prognosis for patients with chronic acute liver failure Provide assessment,early intervention for patients with dangerous prognosis,improve prognosis and prolong survival time.Methods:Selected 215 patients who were clearly diagnosed with ACLF in the Department of Hepatobiliary and Pancreatic Medicine,First Hospital of Jilin University from June 1,2018 to October 1,2020,and collected the general conditions,etiology,laboratory examinations,complications,Whether artificial liver treatment was performed,the 90-day survival status was divided into survival group and death group,and retrospective analysis was performed on the above items.The independent prognostic factors were established to establish a prognostic model,and the ROC curve was drawn to evaluate the prognostic efficacy of the model.Results:(1)Among the 215 patients,118 patients(54.88%)were in the survival group,including 79 male patients(66.95%),39 female patients(33.05%),with an average age of 46.78±10.96 years,and 14 patients with a history of diabetes(8.47%);97 cases(45.12%)in the death group,including 72 male patients(74.23%),39 female patients(25.77%),with an average age of 55.23±10.33 years old,and 14 patients(14.43%)with a history of diabetes.Among the primary causes of liver disease,97 cases of hepatitis B cirrhosis(45.12%),23 cases of severe chronic hepatitis B(10.70%),54 cases of alcoholic cirrhosis(25.12%),and 13 cases of autoimmune liver disease(6.05)%),6 cases of hepatitis C cirrhosis(2.79%),2 cases of hepatitis B cirrhosis with alcoholic liver disease(0.93%),2 cases of hepatitis B cirrhosis with hepatitis E virus infection(0.93%),8 cases of drug-induced liver injury(3.72%),4 cases(1.86%)of hepatolenticular degeneration,6 cases(2.79%)of unexplained liver cirrhosis.(2)Through univariate analysis,the results showed that ALP,ALB,CHE,Na+,and PTA in the death group were significantly lower than those in the survival group,and the difference was statistically significant;TBil,SCr,APTT,INR,WBC count,MELD score,and MELD-Na score were all Significantly higher than the survival group,the difference was statistically significant;the incidence of spontaneous peritonitis,abdominal effusion,gastrointestinal hemorrhage,hepatic encephalopathy,and hepatorenal syndrome were higher than the survival group,and the difference was statistically significant.The number of simultaneous complications between the two groups was counted,and the difference between the groups was statistically significant.(3)According to the results of single factor analysis,combined with the clinical significance of various indicators and avoiding multicollinearity,ALP,ALB,CHE,Na+,PTA,TBil,SCr,APTT,INR,WBC count,MELD score,whether spontaneous peritonitis occurs,Abdominal effusion,gastrointestinal hemorrhage,hepatic encephalopathy,hepatorenal syndrome,etc.were respectively performed single-factor logistic regression,the variables were screened by p value,and the research items with p<0.05 were included in the multivariate logistic regression.Multivariate logistic regression results showed that hepatic encephalopathy,INR,TBil,and age were independent risk factors for the short-term prognosis of ACLF patients,and blood Na+ was an independent protective factor.(4)The prognostic evaluation model THINA was established according to the multivariate logistic regression equation,and the ROC curve was drawn and compared with the MELD and MELD-Na scores.The results showed that the AUC and Youden index of the THINA model were greater than the MELD score and the MELD-Na score,suggesting that the prognostic efficacy is better than the above Two kinds of ratings.Conclusion:(1)The most common cause of chronic liver disease in ACLF patients is HBV-related liver disease(including CHB and hepatitis B cirrhosis),followed by alcoholic liver disease.(2)The middle-aged and elderly patients with ACLF are the most prevalent age group,and the prognosis tends to get worse with age.(3)Once hepatic encephalopathy occurs,the death rate of the patient increases and the prognosis is poor.The more types of complications,the worse the prognosis of patients.(4)Total bilirubin,hepatic encephalopathy,INR,and age are independent risk factors,and blood sodium is an independent protective factor.The prognostic model THINA was established based on independent influencing factors,and its prognostic efficacy was better than MELD score and MELD-Na score.