Risk Factors For Prognosis In Patients With Acute On Chronic Liver Failure Associated With Hepatitis B

Objective:By analyzing the prognostic factors of patients with chronic plus acute liver failure(HBV-ACLF)that affect the hepatitis B virus infection,it will provide a reference for predicting the prognosis of HBV-ACLF patients in the future,and guide the choice of treatment options for clinicians.Methods:A total of 122 patients with HBV-ACLF admitted to the First Affiliated Hospital of Nanchang University from January 2019 to July 2020 were retrospectively analyzed,and the patients with HBV-ACLF were divided into survival and death groups,after which the patients were divided into those with and without cirrhosis according to the presence or absence of cirrhosis,the clinical parameters of the two groups were compared,and Cox regression analysis was applied to find independent risk factors affecting the prognosis of the patients according to Survival curves were plotted for each group of patients stratified by patient risk factors.Results:HBV-ACLF patients were divided into survival and death groups,in which PT,INR,proportion of Esophageal variceal Bleeding(EVB),proportion of Hepatic Encephalopathy(HE)and concomitant cirrhosis were significantly higher(P < 0.05)and PTA was significantly lower(P < 0.05)in the death group compared with the survival group;Patients with HBV-ACLF were divided into those with and without cirrhosis,and those with cirrhosis had significantly higher bun and 28 day mortality and 180 day mortality(P < 0.05),and lower serum sodium and platelets(P < 0.05);Multivariate Cox regression analysis resulted that having Esophageal variceal Bleeding(or: 2.441,95% CI: 1.063-5.605,P = 0.015),PTA < 30%(or: 2.971,95% CI:1.006-8.776,P = 0.049)and concomitant cirrhosis(or = 2.272,95% CI: 1.188-4.345,P = 0.013)were independent prognostic factors for ACLF,that is,lower PTA,worse outcomes in patients with Esophageal variceal Bleeding and concomitant cirrhosis,and significantly worse cumulative survival in patients with cirrhosis than in patients without cirrhosis(log rank test,P = 0.006);The cumulative survival of patients with bleeding was significantly lower than that of patients without bleeding((log rank test,P = 0.026);and that of patients with PTA < 30% was significantly lower than that of patients with PTA > 40%((log rank test,P = 0.011)).Conclusion:Concomitant cirrhosis,presence of Esophageal variceal Bleeding and PTA <30% were independent risk factors for the outcome of HBV-ACLF patients.