Study Of Prognostic Related Factors For Acute-on-chronic Liver Failure

Objective: The acute-on-chronic liver failure (ACLF) is the most commontype of liver failure in China. It is characterized by its complex clinicalmanifestations and high mortality. The article aims to study and analyze theprognostic related factors of ACLF, which are helpful to treatment.Methods: Retrospective analysis was applied in studying the clinicalaspects of164patients with ACLF hospitalized between June2009andDecember2012in hepatobiliary and pancreatic department in the first hospitalof Jilin university． Patients are divided into two groups, improved group anddeath group, according to the results of treatment. Age, gender, serumbiochemistry examination and complications were analyzed to survey whetherthey would influence the prognosis of patients with ACLF. Five scoringsystems, Child-Pugh、MELD、MELD-Na、MESO、i-MELD,were comparedto observe its predictive values for patients with acute-on-chronic liver failure.Results:(1) HBV virus infection is the major cause for the occurrence ofthe acute-on-chronic liver failure, accounted for88cases (53.7%), followed byalcoholic factors and multiple etiology factors.(2) Age, prothrombin time (PT),thrombin time (TT), international normalized ratio (INR), prothrombinactivity (PTA), serum sodium (Na), albumin (ALB), total bilirubin (TBIL),creatinine (Cr), platelets (PLT), fast blood sugar (FBS), infections not byvirous, hepatic encephalopathy, hepatorenal syndrome, electrolyte disorder areassociated with ACLF prognosis by univariate analysis. But when comparedwith alanine aminotransferase (ALT), aspartate aminotransferase (AST),cholinesterase (CHE), total bile acid (TBA), prealbumin （PA）， blood urea nitrogen (BUN), white blood cell (WBC), hemoglobin (HB), alpha-fetoprotein(AFP), upper gastrointestinal bleeding, liver cancer, there is no statisticaldifference between the two groups.(3) Age, serum sodium, INR, non viralinfection and heptorenl syndrome are independent risk factors of ACLF relatedto prognosis, analysed by multivariate analysis of binary logistic regression.(4)The five scoring systems such as Child-Pugh, MELD, MELD-Na, MESO,i-MELD scoring system can all predict the prognosis of ACLF well. Amount ofthem, area under the ROC curve (AUC) of MELD-Na is largest, and itspredicted value is the best.Conclusions:(1) Hepatitis B virus is the main cause of ACLF, followedby alcoholic factors and multiple etiology factors.(2) Serum Na, INR, non viralinfection and heptorenl syndrome are the independent risk factors related toprognosis of ACLF.(3) Child-Pugh, MELD, MELD-Na, MESO, i-MELDscoring systems all have good predictive values, while the best predictive valueis MELD-Na.(4) Some factors such as viral load, AFP are not relevant withprognosis of ACLF, which do not agree with some reports. It may be associatedwith small sample size of our study.