Analysis Of Prognostic Factors And Prognostic Model Construction Of Hepatitis B Virus-related Acute-on-chronic Liver Failure

Objective To explore whether the commonly used clinical indicators are the short-term prognosis’ s influencing factors in patients with hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF),and explore whether a new predictive model with high predictive value can be established on this basis to guide clinical practice,improve patient prognosis and improve patient quality of life.Methods The basic information and clinical data of 82 HBV-ACLF patients who attended our hospital from June 2013～October 2022 were collected.The statistical software was used to retrospectively analyze the clinical data of HBV-ACLF patients,and the independent influencing factors affecting the short-term prognosis of HBV-ACLF patients were obtained by binary Logistic regression analysis,and a new prognostic model was established on this basis.The receiver operating characteristic curve(ROC curve)was used to compare the predictive value of the new prognostic model and the model for end stage liver disease(MELD)score on the short-term prognosis of HBV-ACLF patients.Results 1.A total of 82 patients with HBV-ACLF were enrolled in the study,aged27-81 years,with a mean age of 52.72±12.91 years,of which 63 were men(about 77%)and 19 were women(about 23%).After 3 months of follow-up,there were 45 cases(about 55%)in the survival group and 37 cases(about 45%)in the death group,and there was no significant statistical difference in age and sex between the two groups(P>0.05).There were no significant differences in CRP,WBC,RDW-CV,PLT,ALT,AST,GGT,ALB,Cr,AFP,C3,Ig G and Ig M between the two groups;NLR,TBil and INR in the survival group were significantly lower than those in the death group,and RDW-SD,Na,PTA,FIB and TSH in the survival group were significantly higher than those in the death group(P<0.05).2.The incidence of ascites in the survival group was84.4%,the incidence of ascites in the death group was 83.8%,there was no significant difference between the two groups;the incidence of hepatic encephalopathy(HE)and upper gastrointestinal bleeding in the survival group was 15.6% and 4.4%,and the incidence of hepatic encephalopathy and upper gastrointestinal bleeding in the death group was 45.9% and 21.6%,and there were significant statistical differences between the two groups.3.Meaningful indicators in univariate analysis: NLR,RDW-SD,TBil,Na,PTA,INR,FIB,TSH,hepatic encephalopathy,upper gastrointestinal bleeding as independent variables,and prognostic outcomes as dependent variables,were brought into binary Logistic regression analysis,and it was concluded that TBil,PTA,INR,and hepatic encephalopathy were independent factors influencing the short-term prognosis of patients with HBV-ACLF.4.According to the results of regression analysis,the new prognostic model:Logit(P)= In(P/1-P)=-4.106+0.005×[TBil(μmol/L)]+ 0.986×(INR)+1.475×hepatic encephalopathy(1 with hepatic encephalopathy and 0 without hepatic encephalopathy),has an area under the ROC curve of 0.787,which is better than the MELD score(0.716).Conclusion TBil,PTA,INR,and hepatic encephalopathy are independent factors influencing the short-term prognosis of patients with HBV-ACLF;In the short-term prognosis of patients with HBV-ACLF,the new prognostic model has a higher predictive value.